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
- City
- South St. Paul,
- State
- Minnesota
- ZIP Code
- 55075-1915
- Phone
- (651) 291-7000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Pedorthist |
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