Individual
SUSAN F MICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., PH.D.
Contact information
Practice address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6744
(262) 638-6540
Mailing address
1717 TAYLOR AVE, RACINE, WI 53403-2405
(262) 638-6744
(262) 638-6540
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3113-57
WI
2084N0400X
Neurology Physician
Primary
28735
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356441018
—
WI
Enumeration date
09/23/2006
Last updated
08/22/2013
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