Provider Demographics
NPI:1275733180
Name:MIKESELL, DARREN LAMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:DARREN
Middle Name:LAMAR
Last Name:MIKESELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3318 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-5094
Mailing Address - Country:US
Mailing Address - Phone:307-742-3242
Mailing Address - Fax:307-742-3282
Practice Address - Street 1:2710 HARNEY ST STE 100
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-0001
Practice Address - Country:US
Practice Address - Phone:307-742-3242
Practice Address - Fax:307-742-3242
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7962A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY126564400Medicaid
WYW22102Medicare PIN