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Individual

MIKEL W SKOUSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
457 E 4TH PLACE, MESA, AZ 85203
(480) 833-5383
(480) 833-5385
Mailing address
457 E 4TH PL, MESA, AZ 85203-7154
(480) 833-5383
(480) 833-5385

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1213
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
237190-01
AZ
Enumeration date
09/20/2006
Last updated
08/15/2013
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