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Individual

DR. WILLIAM MICKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
(417) 875-3383
Mailing address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000

Taxonomy

Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
2006006314
MO
207R00000X
Internal Medicine Physician
2006006314
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
148380008
MISSOURI MEDICARE
MO
05
206426207
MO
Enumeration date
01/30/2007
Last updated
12/27/2018
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