# JAMES D. MICKLE, JR. MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cholesterol Studies and Treatment
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477855104
- **Authorized official:** DR. JAMES D. MICKLE JR. MD (SOLE PROPRIETOR)
- **Authorized official phone:** (610) 952-4418

## Contact information

- **Practice address:** 4 CALLE MEDICO, C, SANTA FE, NM 87505-4791
- **Practice address phone:** (610) 952-4418
- **Practice address fax:** (610) 369-2710
- **Mailing address:** 4 CALLE MEDICO, C, SANTA FE, NM 87505-4791
- **Mailing address phone:** (610) 952-4418
- **Mailing address fax:** (610) 369-2710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | MD2008-0397 | NM | Yes |

## Other

- **Enumeration date:** 12/01/2010
- **Last updated:** 12/01/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 502171 | MEDICARE ID | PA |