Individual
JOSEPH DALE MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
624 E FRONT AVE, SPOKANE, WA 99202-2139
(509) 626-9900
Mailing address
PO BOX 31001-4114, PASADENA, CA 91110-0001
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01066154A
IN
207Q00000X
Family Medicine Physician
Primary
MD60456946
WA
Other
Enumeration date
06/25/2007
Last updated
11/26/2025
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