Provider Demographics
NPI:1003013244
Name:JAMES D. MICKLE JR. MD
Entity Type:Organization
Organization Name:JAMES D. MICKLE JR. MD
Other - Org Name:CHOLESTEROL STUDIES AND TREATMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MICKLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:610-369-2050
Mailing Address - Street 1:137 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOYERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19512-1300
Mailing Address - Country:US
Mailing Address - Phone:610-369-2050
Mailing Address - Fax:610-369-2710
Practice Address - Street 1:137 MONTGOMERY AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:BOYERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19512-1300
Practice Address - Country:US
Practice Address - Phone:610-369-2050
Practice Address - Fax:610-369-2710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016977E261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB38961Medicare UPIN
PA502171Medicare ID - Type Unspecified