Individual
DR. CHARLES CHRIS MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 HOSPITAL PL, SOLDOTNA, AK 99669-7559
(907) 714-4444
Mailing address
173 ANTHURIUM ST, SOLDOTNA, AK 99669-7730
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
3497
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD3497
—
AK
01
—
P00464956
MEDICARE RAILROAD
AK
Enumeration date
07/13/2006
Last updated
07/10/2020
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