Provider Demographics
NPI:1487936415
Name:MIKOS, ANNA J (CNM)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:J
Last Name:MIKOS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 W 95TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2572
Mailing Address - Country:US
Mailing Address - Phone:773-319-7341
Mailing Address - Fax:
Practice Address - Street 1:4700 W 95TH ST STE 303
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2572
Practice Address - Country:US
Practice Address - Phone:708-857-7230
Practice Address - Fax:708-425-5779
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.009030363LX0001X
IL209.009016367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology