Samuel Mickle

NPI 1669248407 · on the registry since 2023 · sole proprietor

Practice

Address: 70 Hospitality Dr
Xenia, OH 45385
Phone: (937) 376-5632
Fax: (937) 376-5490
Organisation at this address: Wal-Mart Stores East Lp
Wal-Mart Stores East, Lp
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 9

Registry record

Primary taxonomy: 156FX1800X
156FX1800X
Licence states on file: OH
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2023-12-04

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Ohio