Individual
LORIN MICKELSEN IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
4233 GATEWAY BLVD, NEWBURGH, IN 47630
(812) 858-5786
(812) 490-4512
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 858-5786
(812) 490-4512
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07001281A
IN
213E00000X
Podiatrist
243967
KY
213ES0103X
Foot & Ankle Surgery Podiatrist
00433
KY
Other
Enumeration date
07/13/2015
Last updated
11/19/2019
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