Individual
JOSEPH EDWARD MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6500 E 2ND ST, SUITE 200, CASPER, WY 82609-4338
(307) 577-5100
(307) 234-1201
Mailing address
6500 E 2ND ST, SUITE 200, CASPER, WY 82609-4338
(307) 577-5100
(307) 234-1201
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5638A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315272
BC/BS
WY
Enumeration date
09/20/2005
Last updated
08/11/2020
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