Individual
SUSAN MIKKELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-3546
Mailing address
3503 NE STANTON ST, PORTLAND, OR 97212-2746
(503) 245-5107
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD00045975
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD24386
OR
207RP1001X
Pulmonary Disease Physician
MD00045975
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD24386
OR
Other
Enumeration date
08/21/2006
Last updated
02/05/2015
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