Ira Mickelson
Obstetrician & Gynecologist Family Doctor - Addiction Medicine
1777 Axtell Suite 102
Troy
, Michigan 48084
Ira Mickelson
Obstetrician & Gynecologist Family Doctor - Addiction Medicine
1777 Axtell Suite 102
Troy
, Michigan 48084
(248) 822-6200
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About
Features
Specialties
- Family Doctor - Addiction Medicine
- Obstetrician & Gynecologist
Languages spoken
- English
Location
First Address
- Ira Mickelson
- 1777 Axtell Suite 102
- Troy, MI
- Zip : 48084
- Phone : (248) 822-6200
Second Address
- Ira Mickelson
- 1777 Axtell Suite 102
- Troy, MI
- Zip : 48084
- Phone : (248) 822-6200
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FAQs
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207QA0401X | Family Doctor - Addiction Medicine | 5304001863 | MI |
| Y | 207V00000X | Obstetrician & Gynecologist | IM043839 | MI |
National Provider Identifier
| NPI | 1760576516 |
|---|---|
| Provider Name | Ira Mickelson |
| First Address | Troy, MI 48084 |
| Second Address | Troy, MI 48084 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/10/2006 |
| Last Update Date | 13/11/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 160F318220 | BCBS OF MICHIGAN (01) | MI |
| B46469 | (02) | MI |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.