Individual
ROBERT H MIKKELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8485
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8485
(920) 926-8908
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
20061
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020048727
RAILROAD MEDICARE
WI
05
—
31076000
—
WI
Enumeration date
11/16/2005
Last updated
11/17/2020
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