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1801073655
TRACY D. MICKELSEN
MERIDIAN, ID
NPI
1801073655
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: ID 178692)
Enumeration Date
2008-01-23
Last Update Date
2017-12-07
Business Address
Mr. TRACY D. MICKELSEN CSFA
3015 E MAGIC VIEW DR
MERIDIAN, ID 83642-3743
Phone number: 208-855-2410
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Mailing Address
Mr. TRACY D. MICKELSEN CSFA
3015 E MAGIC VIEW DR
MERIDIAN, ID 83642-3743
Phone number: 208-855-2410
Copy
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