Provider Demographics
NPI:1164497806
Name:MICKELS, JASON JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:MICKELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 W CENTER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4375
Mailing Address - Country:US
Mailing Address - Phone:402-691-1560
Mailing Address - Fax:402-505-6249
Practice Address - Street 1:11704 W CENTER RD
Practice Address - Street 2:STE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4375
Practice Address - Country:US
Practice Address - Phone:402-691-1560
Practice Address - Fax:402-505-6249
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23524207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE093431OtherNE MEDICARE GROUP
NE47053349212OtherNE MEDICAID
NE23524OtherNE MEDICAL LICENSE
IA999334OtherIA MEDICAID
NEP00326801OtherRR MEDICARE
NECJ6643OtherRR MEDICARE GROUP
NE280150Medicare PIN
NE093431OtherNE MEDICARE GROUP
NEI55302Medicare UPIN