Provider Demographics
NPI:1730514100
Name:MIKHAIL, CHRISTINA ALISE (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ALISE
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ALISE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:MLC 2016
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4726
Mailing Address - Fax:513-636-2808
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:MLC 2016
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4726
Practice Address - Fax:513-636-2808
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTC220363AM0700X
OH50.005058RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical