Individual
DR. MATTHEW J MICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6175 RIVERLAKE BLVD, BARTOW, FL 33830-7754
(414) 559-2141
(863) 646-7292
Mailing address
6175 RIVERLAKE BLVD, BARTOW, FL 33830-7754
(414) 559-2141
(863) 646-7292
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
35056
WI
207RI0011X
Interventional Cardiology Physician
Primary
00027578
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009939093
—
AL
Enumeration date
07/21/2005
Last updated
07/06/2011
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