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Individual
IRA MICKELSON
Active
Individual
IRA MICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
5304001863
MI
207V00000X
Obstetrics & Gynecology Physician
Primary
IM043839
MI
Other
Enumeration date
10/03/2006
Last updated
11/13/2018
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