MEDICARE: MORRIS L MICKELSON MD

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	207R00000X	Internal Medicine Physician	36178	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8U3654	OTHER	TX	BCBS INDIVIDUAL PROVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922173616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MORRIS L MICKELSON MD

Provider Business Mailing Address
First Line	:	4331 E ALLEN RD
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48855-8213
Country	:	US
Telephone Number	:	248-229-7916
Fax Number	:	248-759-8457

Provider Business Practice Location Address
First Line	:	4331 E ALLEN RD
Second Line	:
City	:	HOWELL
State	:	MI
Zip	:	48855-8213
Country	:	US
Telephone Number	:	248-229-7916
Fax Number	:	248-759-8457

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	02/02/2026

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