Individual
MIKAH J BANGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30342 PIKE 221, EOLIA, MO 63344-4605
(573) 560-0567
Mailing address
30342 PIKE 221, EOLIA, MO 63344-4605
(573) 560-0567
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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