Provider Demographics
NPI:1487037909
Name:MIKEL, BRYCE (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:
Last Name:MIKEL
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:PO BOX 732031
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2031
Mailing Address - Country:US
Mailing Address - Phone:866-429-6045
Mailing Address - Fax:
Practice Address - Street 1:2121 E HARMONY RD UNIT 300
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3403
Practice Address - Country:US
Practice Address - Phone:970-221-9104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61142207R00000X
CODR.0069246207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine