Individual
MR. MICAHEL JOHN HUMEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
ATC, MED
Contact information
Practice address
159 KESTREL RD, MOUNTAIN TOP, PA 18707-2605
(570) 868-3131
Mailing address
159 KESTREL RD, MOUNTAIN TOP, PA 18707-2605
(570) 868-3131
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
RT001759A
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RT001759A
STATE LICENSE
PA
Enumeration date
08/17/2005
Last updated
07/08/2007
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