Organization
INTEGRATED CARE CLINICS, PA
Active
Other names
Great River Spine & Sport
Organization subpart
No
Provider details
NPI number
Authorized official
BILL E MICKLE DC (OWNER)
(763) 260-8401
Entity
Organization
Contact information
Practice address
1260 HIGHWAY 25 S, MONTICELLO, MN 55362-8921
(763) 260-8401
(763) 295-2208
Mailing address
1260 HIGHWAY 25 S, MONTICELLO, MN 55362-8921
(763) 263-8401
(763) 263-5900
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
44760
MN
2081P0004X
Spinal Cord Injury Medicine Physician
44760
MN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
44760
—
208VP0014X
Interventional Pain Medicine Physician
44760
MN
225100000X
Physical Therapist
Primary
8397
MN
363LF0000X
Family Nurse Practitioner
R182757-0
MN
Other
Enumeration date
07/04/2006
Last updated
10/18/2019
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