Individual
PHILIP M MICKSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
5300 MEMORIAL DR, SUITE 303, TWO RIVERS, WI 54241-3923
(920) 793-6550
(920) 793-6551
Mailing address
5300 MEMORIAL DR, SUITE 303, TWO RIVERS, WI 54241-3923
(920) 793-6550
(920) 793-6551
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
6871-33
WI
363LF0000X
Family Nurse Practitioner
6871 - 33
WI
Other
Enumeration date
03/01/2016
Last updated
04/23/2020
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