Individual
DR. TOMMY MIKKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2799 W GRAND BLVD, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202-2608
(313) 916-2436
Mailing address
2799 W GRAND BLVD, 2799 WEST GRAND BOULEVARD, DETROIT, MI 48202-2608
(313) 916-2436
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
062472
MI
207T00000X
Neurological Surgery Physician
Primary
4301062472
MI
2084N0400X
Neurology Physician
4301062472
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303982210
—
MI
01
—
700H262230
BLUE CROSS-BLUE CROSS
—
01
—
TM062472
CHAMPUS-CHAMPUS
—
Enumeration date
11/21/2006
Last updated
03/31/2020
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