Individual
DR. LAURIE ELIZABETH MICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10512 N 110TH EAST AVE, SUITE 300, OWASSO, OK 74055-6636
(918) 376-8901
(918) 376-8939
Mailing address
10512 N 110TH EAST AVE, SUITE 300, OWASSO, OK 74055-6636
(918) 376-8901
(918) 376-8939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
17332
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100090800A
—
OK
Enumeration date
05/19/2006
Last updated
05/03/2014
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