Individual
DR. CHARLES BAZEMORE MIKELL III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HSC T12, ROOM 080, STONY BROOK, NY 11794-8122
(631) 444-1116
Mailing address
HSC T12, ROOM 080, STONY BROOK, NY 11794-8122
(631) 444-1116
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
273606
NY
207T00000X
Neurological Surgery Physician
TP008
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/07/2009
Last updated
09/27/2016
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