Individual
ANDREW MICKLUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(208) 376-7083
Mailing address
12553 W EXPLORER DR STE 190, BOISE, ID 83713-1612
(208) 376-7083
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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