Mickelsen, Phillip Lee
Mickelsen, Phillip Lee is an individual health care provider with primary practice located at 6420 56Th Ave , Kearney NE 68845-0380. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Mickelsen, Phillip Lee can be contacted via phone (308) 224-2062.Contact Information
Primary practice address
6420 56Th Ave
Kearney NE 68845-0380
Phone: (308) 224-2062
Fax: (888) 974-5962
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 107063 | Minnesota |
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 32312 | Nebraska |
Profile Details
| NPI number | 1518960012 |
|---|---|
| LBN Legal business name | Mickelsen, Phillip Lee |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2005 |
| Last updated | Jan 30th, 2020 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1518960012 | NPPES |
| New Mexico | Other | 967331 | PRONET / AETNA |
| New Mexico | MEDICAID | 43227252 | PRONET / AETNA |
| New Mexico | MEDICAID | 859457 | PRONET / AETNA |
| New Mexico | MEDICAID | 86929 | PRONET / AETNA |
| New Mexico | Other | 107063 | PRONET / AETNA |
| New Mexico | Other | NM009R60 | PRONET / AETNA |
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