Healthcare Provider Details

I. General information

NPI: 1164532180
Provider Name (Legal Business Name): ROBERT ALLEN MICKEL MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/23/2021
Certification Date: 09/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST SUITE 505
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

112 HOWARD DR
TIBURON CA
94920-1448
US

V. Phone/Fax

Practice location:
  • Phone: 415-751-4914
  • Fax: 415-751-1414
Mailing address:
  • Phone: 415-999-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberG43934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: