Individual
DEREK MICHAELIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
213 W 1ST ST, DULUTH, MN 55802-1909
(218) 727-1004
Mailing address
213 W 1ST ST, DULUTH, MN 55802-1909
(218) 727-1004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3625
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/07/2019
Last updated
06/11/2019
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