Provider Demographics
NPI:1265408330
Name:MIHOK, A. JONATHAN (DO)
Entity type:Individual
Prefix:DR
First Name:A. JONATHAN
Middle Name:
Last Name:MIHOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 GLADE GULCH RD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-9663
Mailing Address - Country:US
Mailing Address - Phone:303-308-1106
Mailing Address - Fax:
Practice Address - Street 1:24300 E SMOKY HILL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-1387
Practice Address - Country:US
Practice Address - Phone:303-341-4411
Practice Address - Fax:303-330-0732
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42164207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02522730Medicaid
CO42232538Medicaid
CO42232538Medicaid
COC810865Medicare PIN