MEDICARE: SCOTT ANTHONY MIKESELL DO

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	207RC0000X	Cardiovascular Disease Physician	52837	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881684942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ANTHONY MIKESELL DO

Provider Business Mailing Address
First Line	:	1001 E SUPERIOR ST
Second Line	:	STE. L201
City	:	DULUTH
State	:	MN
Zip	:	55802-2207
Country	:	US
Telephone Number	:	218-249-3057
Fax Number	:	218-249-3091

Provider Business Practice Location Address
First Line	:	1001 E SUPERIOR ST
Second Line	:	STE. L201
City	:	DULUTH
State	:	MN
Zip	:	55802-2207
Country	:	US
Telephone Number	:	218-249-3057
Fax Number	:	218-249-3091

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

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	12/04/2020

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