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Individual

CHARLES MIKOW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PAC

Contact information

Practice address
220 DOUGLAS ST, CHETEK, WI 54728-8953
(715) 924-4811
Mailing address
PO BOX 1510, EAU CLAIRE, WI 54702-1510
(715) 838-5222

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
411
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1679672091
WI
Enumeration date
09/22/2006
Last updated
08/19/2013
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