Individual
CARL TERENCE MICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 GUSTAVE L LEVY PL, BOX 1149, NEW YORK, NY 10029-6504
(612) 618-7945
Mailing address
1 GUSTAVE L LEVY PL, BOX 1149, NEW YORK, NY 10029-6504
(612) 618-7945
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
294040
NY
207P00000X
Emergency Medicine Physician
326621
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Enumeration date
03/26/2014
Last updated
06/24/2022
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