MEDICARE: MR. STEVEN DON MICKELSON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA05217	TX
2	363A00000X	Physician Assistant	PA65992	CA

General Provider Information

NPI Number	:	1477673804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN DON MICKELSON PA

Provider Business Mailing Address
First Line	:	7800 SHOAL CREEK BLVD
Second Line	:	STE 205-N
City	:	AUSTIN
State	:	TX
Zip	:	78757-1098
Country	:	US
Telephone Number	:	512-206-4300
Fax Number	:	512-206-4376

Provider Business Practice Location Address
First Line	:	651 1ST ST W STE L
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-7046
Country	:	US
Telephone Number	:	415-927-0666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	04/04/2025

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