Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Charles Bazemore Mikell III, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1124254917

Dr. Charles Bazemore Mikell III, MD is a Neurosurgery in Stony Brook, New York. Graduated from University of Missouri, Columbia School of Medicine in 2009, 17 years ago. Practices with New York Spine and Brain Surgery, University Faculty Practice Corporat, a 59-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Kentucky and New York.

Years since qualifying
17
Trained at
University of Missouri, Columbia School of Medicine
Licensed in
KY, NY
In the registry since
2009
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

Hsc T12 Rm 080
Stony Brook, NY 11794-8122
Phone: (631) 444-1116
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurological Surgery Physician (primary) Taxonomy 207T00000X · Licence 273606 (NY)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X
Neurological Surgery Physician Taxonomy 207T00000X · Licence TP008 (KY)

Record details

NPI number1124254917
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 7, 2009
Last updated in NPPESSeptember 27, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNEUROSURGERY
Medical schoolUNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
Graduated 2009 (17 years in practice)
Group practice New York Spine And Brain Surgery, University Faculty Practice Corporat — 59 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Stony Brook