Individual
DR. JASON JOHN MICKELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11704 W CENTER RD, STE 200, OMAHA, NE 68144-4375
(402) 691-1560
(402) 505-6249
Mailing address
11704 W CENTER RD, STE 200, OMAHA, NE 68144-4375
(402) 691-1560
(402) 505-6249
Taxonomy
Speciality
Code
Description
License number
State
207XS0106X
Orthopaedic Hand Surgery Physician
Primary
23524
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093431
NE MEDICARE GROUP
NE
01
—
23524
NE MEDICAL LICENSE
NE
01
—
47053349212
NE MEDICAID
NE
01
—
999334
IA MEDICAID
IA
01
—
CJ6643
RR MEDICARE GROUP
NE
01
—
P00326801
RR MEDICARE
NE
Enumeration date
02/17/2006
Last updated
02/06/2008
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