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General NPI Number Information
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NPI Number | 1376539205
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Entity Type | Individual
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Provider Name | STEVEN P MICKLEY MD
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 7 RIVERSVILLE RD
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City | GREENWICH
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State | CT
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Zip | 06831-3627
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Country | US
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Telephone | 203-531-1808
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Fax | 203-831-8326
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Provider Business Mailing Address
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Address Line | 7 RIVERSVILLE RD
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City | GREENWICH
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State | CT
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Zip | 06831-3627
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Country | US
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Telephone | 203-531-8326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 016644
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 117123
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License Number State | NY
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