Individual
DR. JUDITH K MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
117 TRAIL CREEK CT, COTTLEVILLE, MO 63304-7594
(513) 543-0595
Mailing address
117 TRAIL CREEK CT, COTTLEVILLE, MO 63304-7594
(513) 543-0595
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
35-078636
OH
174400000X
Specialist
MD24100
ME
207RC0000X
Cardiovascular Disease Physician
Primary
2017039388
MO
207RC0000X
Cardiovascular Disease Physician
35-078636
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060068472
RAILROAD MEDICARE
—
05
—
2209176
—
OH
Enumeration date
10/26/2005
Last updated
03/12/2025
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