Individual
JENNIFER MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2300 N CHILDRENS PLZ # 24, DIVISION OF UROLOGY - CHILDRENS MEMORIAL HOSPITAL, CHICAGO, IL 60614-3363
(773) 880-4000
Mailing address
1730 N CLARK ST APT 3610, CHICAGO, IL 60614-5395
(312) 929-3865
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
036.117785
IL
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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