Individual
GREGORY MICKLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 NORTHCREST DR, SPRINGFIELD, TN 37172-3927
(931) 647-5034
(931) 552-6663
Mailing address
PO BOX 305172, DEPT # 109, NASHVILLE, TN 37230-5172
(931) 647-5034
(931) 552-6663
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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