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General NPI Number Information
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NPI Number | 1245559012
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Entity Type | Organization
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Legal Business Name | PLACEBO VENTURES, LLC
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 5715 E 2ND ST
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City | CASPER
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State | WY
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Zip | 82609-4322
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Country | US
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Telephone | 307-265-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 S WALNUT ST
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City | CASPER
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State | WY
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Zip | 82601-6248
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Country | US
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Telephone | 307-265-0947
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH EDWARD MICKELSON
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Credential | M.D.
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Telephone | 307-265-0947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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