| Provider / Organization | NPI | Date Certified |
|---|---|---|
| CHARLES ANTHONY MIKULKA | 1740884683 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Charles Anthony Mikulka Jr. |
| Practice Office Address | 706 W MAIN ST NEW HOLLAND, PA US |
| Practice Office Telephone | 7173544268 |
| Practice Office Fax | 7173555196 |
| Mailing Address | 706 W MAIN ST NEW HOLLAND, PA 175579328 US |
| Business Telephone | 7173544268 |
| Business Fax | 7173555196 |
| Code | License No | State |
|---|---|---|
| 183500000X PRIMARY | RP040215L | PA |