Search › Wisconsin › 363LF0000X
Matthew Mickelson
NPI 1942907647 · on the registry since 2023
Practice
- Address
- 4200 Savannah Dr
Deforest, WI 53532 - Phone
- (608) 417-3300
- Clinicians at this address
- 9
Registry record
- Primary taxonomy
- 363LF0000X
363LF0000X
- Also registered as
- 163W00000X
- Licence states on file
- WI
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2023-09-12
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 Wisconsin