TRACY D. MICKELSEN

MERIDIAN, ID
NPI1801073655
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AS0400X Physician Assistant Surgical
(Licence: ID  178692)
Enumeration Date2008-01-23
Last Update Date2017-12-07
Business Address
MR. TRACY D. MICKELSEN CSFA
3015 E MAGIC VIEW DR
MERIDIAN, ID 83642-3743
Phone number: 208-855-2410
Mailing Address
MR. TRACY D. MICKELSEN CSFA
3015 E MAGIC VIEW DR
MERIDIAN, ID 83642-3743
Phone number: 208-855-2410
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