Individual
JOHN MICHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8 GUM TREE DR, OXFORD, MS 38655-6175
(715) 209-7987
Mailing address
8 GUM TREE DR, OXFORD, MS 38655-6175
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT0909
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000016781
CERTIFICATION NUMBER
—
Enumeration date
08/10/2019
Last updated
08/10/2019
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