MEDICARE: CAROLYN M MICEK CA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	876-55	WI

General Provider Information

NPI Number	:	1285009175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN M MICEK CA

Provider Business Mailing Address
First Line	:	715 HILL ST STE 270
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3572
Country	:	US
Telephone Number	:	608-445-6578
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 HILL ST STE 270
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-3572
Country	:	US
Telephone Number	:	608-445-6578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	12/03/2015

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Directions to “ CAROLYN M MICEK CA” Practice Location

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