Individual
MARK D MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4050 COON RAPIDS BLVD NW, COON RAPIDS, MN 55433-2522
(612) 262-1220
Mailing address
114 W 7TH ST STE 900, AUSTIN, TX 78701-3013
(512) 838-4264
(512) 838-4264
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2017034370
MO
2084P0800X
Psychiatry Physician
25MA07643400
NJ
2084P0800X
Psychiatry Physician
308-320
WI
2084P0800X
Psychiatry Physician
Primary
64833
MN
Other
Enumeration date
07/10/2006
Last updated
10/14/2019
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