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1417987686
BRANDON C MICKELSEN
POCATELLO, ID
NPI
1417987686
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: ID o-0450)
Enumeration Date
2006-07-04
Last Update Date
2011-09-22
Business Address
-- BRANDON C MICKELSEN D.O.
1951 BENCH RD SUITE B
POCATELLO, ID 83201-2073
Phone number: 208-238-1000
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Mailing Address
-- BRANDON C MICKELSEN D.O.
1951 BENCH RD SUITE B
POCATELLO, ID 83201-2073
Phone number: 208-238-1000
Copy
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