Individual
DR. MIKEL HEADFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
2020016496
MO
207X00000X
Orthopaedic Surgery Physician
Primary
75959
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2015
Last updated
10/29/2021
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