Individual
ANDREW SIMON MICKLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3999 DUTCHMANS LN, SUBURBAN MEDICAL PLAZA I STE 2G, LOUISVILLE, KY 40207-4729
(502) 893-0491
(502) 895-7360
Mailing address
3999 DUTCHMANS LN, SUBURBAN MEDICAL PLAZA I STE 2G, LOUISVILLE, KY 40207-4729
(502) 893-0491
(502) 895-7360
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
19746
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64197460
—
KY
Enumeration date
07/08/2005
Last updated
02/29/2012
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