Individual
JULIE MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2311 N PROSPECT AVE, MILWAUKEE, WI 53211-4445
(414) 319-3000
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 319-3000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
37828
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32234000
—
WI
01
—
5095123
AETNA
WI
Enumeration date
06/22/2005
Last updated
06/12/2012
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