Individual
WENDY MIKKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2801 W KINNICKINNIC RIVER PKWY, SUITE 165, MILWAUKEE, WI 53215-3669
(414) 385-2301
(414) 385-8791
Mailing address
2801 W KINNICKINNIC RIVER PKWY, SUITE 165, MILWAUKEE, WI 53215-3669
(414) 385-2301
(414) 385-8791
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
25658-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020050375
RAILROAD MEDICARE
WI
05
—
30582600
—
WI
Enumeration date
05/23/2006
Last updated
10/25/2011
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