Provider Demographics
NPI:1639269921
Name:MICKELSON, ANTHONY BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BERNARD
Last Name:MICKELSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:USAMEDDAC WUERZBURG UNIT26610
Mailing Address - Street 2:ATTN: CREDENTIALS OFFICE
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAHC KATTERBACH
Practice Address - Street 2:UNIT 28614
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09177
Practice Address - Country:DE
Practice Address - Phone:0114998-118-3811
Practice Address - Fax:1004998-118-3854
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
PAMD070474L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry