Healthcare Provider Details

I. General information

NPI: 1467508168
Provider Name (Legal Business Name): HEATHER FLORENCE MIKESELL M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVE CENTER FOR HUMAN GENETICS, LAKESIDE 1500
CLEVELAND OH
44106-1716
US

IV. Provider business mailing address

11100 EUCLID AVE CENTER FOR HUMAN GENETICS, LAKESIDE 1500
CLEVELAND OH
44106-1716
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-7234
  • Fax: 216-844-7497
Mailing address:
  • Phone: 216-844-7234
  • Fax: 216-844-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: