Healthcare Provider Details

I. General information

NPI: 1316944044
Provider Name (Legal Business Name): DANNY D. MIKESELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 HARVEY ST STE 201
MUSKEGON MI
49442-4274
US

IV. Provider business mailing address

684 HARVEY ST STE 201
MUSKEGON MI
49442-4274
US

V. Phone/Fax

Practice location:
  • Phone: 231-773-7837
  • Fax: 231-773-7943
Mailing address:
  • Phone: 231-773-7837
  • Fax: 231-773-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDM007231
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: