MR. Charles Glen Mickelson, C.PED.

NPI #1568773679 in South St. Paul,, Minnesota

Provider Information

NPI Number
1568773679
Entity Type
Individual
Name
MR. Charles Glen Mickelson, C.PED.
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Pedorthist
Credential
C.PED.
Enumeration Date
Jun 24, 2010
Last Updated
Nov 9, 2010

Practice Location

Address
423 12TH AVE. NORTH
ZIP Code
55075-1915
Phone
(651) 291-7000

Specialties & Taxonomy Codes

Specialty
Pedorthist

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