Mickelson, Ira

Mickelson, Ira is an sole proprietor health care provider with primary practice located at 1777 Axtell Suite 102, Troy MI 48084. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Addiction Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Mickelson, Ira can be contacted via phone (248) 822-6200.

Contact Information

Primary practice address
1777 Axtell Suite 102 Troy MI 48084
Phone: (248) 822-6200
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Addiction Medicine 207QA0401X 5304001863 Michigan
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X IM043839 Michigan

Profile Details

NPI number 1760576516
LBN Legal business name Mickelson, Ira
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 3rd, 2006
Last updated Nov 13th, 2018 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760576516 NPPES
Michigan Other 160F318220 BCBS OF MICHIGAN

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