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Physicians Anesthesiology Pain Medicine

Provider NPI: 1396775110

Organization Information:
Organization is not Subpart
Authorized Official:  BILL E MICKLE  OWNER  763-260-8401

Practice Location:
1260 HIGHWAY 25 S  MONTICELLO, MN 55362-8921 US
Tel: 763-260-8401  Fax: 763-295-2208

Business Mailing Address:
1260 HIGHWAY 25 S  MONTICELLO, MN 55362-8921 US
Tel: 763-263-8401  Fax: 763-263-5900

NPI Information:
NPI: 1396775110
Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Pain Medicine
Physical Medicine & Rehabilitation
Physical Medicine & Rehabilitation
Pain Medicine
Y225100000XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Physical Therapist
N363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 225100000X





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