Individual
KURT PHILLIP MICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15100 RESCUE WAY, CLEARWATER, FL 33762
(727) 535-1437
(727) 535-4190
Mailing address
155 LARGS CT # 2-207, DUNEDIN, FL 34698-8387
(808) 375-9232
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
10/10/2006
Last updated
07/08/2007
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