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General NPI Number Information
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NPI Number | 1457458358
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Entity Type | Individual
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Provider Name | MIKEL W SKOUSEN DO
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/15/2013
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Provider Practice Location Address
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Address Line | 457 E 4TH PLACE
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City | MESA
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State | AZ
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Zip | 85203
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Country | US
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Telephone | 480-833-5383
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Fax | 480-833-5385
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Provider Business Mailing Address
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Address Line | 457 E 4TH PL
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City | MESA
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State | AZ
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Zip | 85203-7154
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Country | US
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Telephone | 480-833-5383
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Fax | 480-833-5385
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1213
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License Number State | AZ
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