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Individual
GREGORY MICKLOW
Active
Individual
GREGORY MICKLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
45339
TN
207P00000X
Emergency Medicine Physician
Primary
81596
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06040
BLUE SHIELD OF FL
FL
01
—
196453355
CHAMPUS
FL
05
—
264082100
—
FL
Enumeration date
06/16/2006
Last updated
04/17/2014
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