Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | C10003715 | DE |
Y | 207ND0101X | MOHS-Micrographic Surgeon | C1-0003715 | DE |
N | 207NS0135X | Procedural Dermatology | C1-0003715 | DE |
NPI | 1275597114 |
---|---|
Provider Name | Dr. Mitchell Christopher Stickler |
First Address | Lewes, DE 19958 |
Second Address | Lewes, DE 19958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 12/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000431701 | (05) | DE |
E87878 | (02) |