Organization
JAMES D. MICKLE, JR. MD
Active
Other names
Cholesterol Studies and Treatment
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES D. MICKLE JR. MD (SOLE PROPRIETOR)
(610) 952-4418
Entity
Organization
Contact information
Practice address
4 CALLE MEDICO, C, SANTA FE, NM 87505-4791
(610) 952-4418
(610) 369-2710
Mailing address
4 CALLE MEDICO, C, SANTA FE, NM 87505-4791
(610) 952-4418
(610) 369-2710
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
MD2008-0397
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
502171
MEDICARE ID
PA
Enumeration date
12/01/2010
Last updated
12/01/2010
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