MICHAEL CHARLES LICK

BLOOMINGTON, MN
NPI1023793932
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
Enumeration Date2023-06-19
Last Update Date2025-01-13
Business Address
MICHAEL CHARLES LICK
4300 MARKET PTE DR STE 100
BLOOMINGTON, MN 55435-5435
Phone number: 457-495-2767
Mailing Address
MICHAEL CHARLES LICK
115 W 5TH ST # 2
DULUTH, MN 55806-2729
Phone number: 612-708-8024
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