National Provider Identifier
Cody Brad Mickelsen, MD
Cody Brad Mickelsen, MD is listed in the NPPES registry with a primary specialty of Anesthesiology Physician in Rochester, NY and a listed phone number of (585) 275-1384.
Profile Overview
- NPI
- 1013159003
- Provider Type
- Individual
- Primary Specialty
- Anesthesiology Physician
- Enumeration Date
- April 06, 2009
- Last Updated
- June 16, 2016
Practice Location
- 601 Elmwood Ave
- Box 604
- Rochester, NY 14642-0001
Phone: (585) 275-1384
Mailing Address
- 274 N Main St
- Box 604
- Logan, UT 84321-3915
Specialties
- Anesthesiology Physician (207L00000X)
- Student in an Organized Health Care Education/Training Program (390200000X)
Full Record
- NPI
- 1013159003
- Entity Type
- Individual
- Last Name
- Mickelsen
- First Name
- Cody
- Middle Name
- Brad
- Credential
- MD
- Mailing Street Address
- 274 N Main St
- Mailing Address Line 2
- Box 604
- Mailing City
- Logan
- Mailing State
- UT
- Mailing ZIP Code
- 84321-3915
- Mailing Country
- US
- Mailing Phone
- (435) 753-1600
- Practice Street Address
- 601 Elmwood Ave
- Practice Address Line 2
- Box 604
- Practice City
- Rochester
- Practice State
- NY
- Practice ZIP Code
- 14642-0001
- Practice Country
- US
- Practice Phone
- (585) 275-1384
- Practice Fax
- (585) 276-0122
- Enumeration Date
- April 06, 2009
- Last Updated
- June 16, 2016
- Sex
- Male
- Sole Proprietor
- Yes
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Anesthesiology Physician (207L00000X), Student in an Organized Health Care Education/Training Program (390200000X)