DR. JUDITH K MICKELSON (NPI# 1700876190) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700876190 |
| Entity Type | Individual |
| Full Name | DR. JUDITH K MICKELSON |
| Credential | M.D. |
| Practice Address |
60 High St Lewiston ME 04240-7616 |
| Mailing Address |
3219 Clifton Avenue Suite 400 Cincinnati OH 45220-3099 |
| Practice Telephone | 2077533900 |
| Practice Fax Number | 2077533902 |
| Mailing Telephone | 5138611260 |
| Mailing Fax Number | 5138728014 |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2020-11-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | MD24100 | ME | Other Service Providers |
| N | 174400000X | Specialist | 35-078636 | OH | Other Service Providers |
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
35-078636 | OH | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| RAILROAD MEDICARE | 060068472 | 01 | |
| OH | 2209176 | 05 |
| Street Address |
60 HIGH ST |
| City | LEWISTON |
| State | ME |
| Zip Code | 04240-7616 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578558532 | Richard S Shulman | Internal Medicine | 60 High St, Lewiston, ME 04240-7616 | 2005-09-15 |
| 1316590946 | Jonathan Mcdonough | Physician Assistant | 60 High St, Cmhvi Y1, Lewiston, ME 04240-7616 | 2019-07-23 |
| 1740841311 | Jade Elaine Bowden Stuart | Speech-Language Pathologist | 60 High St, Lewiston, ME 04240-7616 | 2019-06-25 |
| 1093299463 | Lindsay Rose Houlihan | Physician Assistant | 60 High St, Lewiston, ME 04240-7616 | 2018-09-20 |
| 1508346768 | Kirsten Haas | Physician Assistant | 60 High St, Lewiston, ME 04240-7616 | 2018-08-17 |
| 1043671506 | Karen Shepard | Nurse Practitioner | 60 High St, Lewiston, ME 04240-7616 | 2016-03-11 |
| 1699136135 | Kari Price-cain | Nurse Practitioner | 60 High St, Lewiston, ME 04240-7616 | 2016-03-11 |
| 1881091387 | Tiffany Eisenhauer | Physician Assistant | 60 High St, Lewiston, ME 04240-7616 | 2014-11-26 |
| 1740541317 | Susan R Horton | Nurse Practitioner | 60 High St, Lewiston, ME 04240-7616 | 2012-05-31 |
| 1245516723 | Kevin Taylor Quigley | Physician Assistant | 60 High St, Lewiston, ME 04240-7616 | 2011-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538773882 | Hannah Page Guerrette | Speech-Language Pathologist | 2 Strawberry Ave, Lewiston, ME 04240 | 2020-09-03 |
| 1497392500 | Samuel C Larouche | Social Worker | 100 Campus Ave Stes A&b, Lewiston, ME 04240 | 2019-12-09 |
| 1972145019 | Pomarand Behavioral Services | Nurse Practitioner | 217 Main St., Suite 201, Lewiston, ME 04240 | 2019-10-10 |
| 1396248258 | William Bucklin | Counselor | 17 Main St Fl 2, Lewiston, ME 04240 | 2018-03-16 |
| 1548769524 | Kevin Ryan | Physician Assistant | 12 High Street Suite 102, Lewiston, ME 04240 | 2018-02-06 |
| 1033637673 | Wellness Center | Clinic/Center | 37 Park Street, Suite 305, Lewiston, ME 04240 | 2017-09-04 |
| 1710404561 | Colasante Chiropractic, LLC | Clinic/Center | 184 Webster Street, #100, Lewiston, ME 04240 | 2017-08-23 |
| 1609398544 | Lindsey Laforge | Occupational Therapist | 984 1/2 Sabattus Street, Lewiston, ME 04240 | 2017-07-12 |
| 1861922478 | Seth Toothaker | Counselor | 1190 Lisbon Street, Lewiston, ME 04240 | 2017-06-15 |
| 1861850828 | Black Bear Support Services, LLC | Community/Behavioral Health | 571 Sabattus Street, Suite 15, Lewiston, ME 04240 | 2016-02-05 |
| Find all providers in zip 04240 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699328823 | Megan Elaine Mackenzie | Specialist | 588 Sandlewood Dr, Lewiston, NY 14092-1110 | 2019-07-17 |
| 1033653639 | Samuel Tepper | Specialist | 207 Thain Rd, Lewiston, ID 83501-4829 | 2016-12-15 |
| 1871937086 | Allison Marie Perfetti | Specialist | 4919 Creek Road Ext, Lewiston, NY 14092-1846 | 2013-04-18 |
| 1912190489 | Lewis Charles Garlow | Specialist | 765 Center St, Lewiston, NY 14092-1705 | 2007-08-19 |
| 1407056658 | Child Development Services Androscoggin | Specialist | 1567 Lisbon St, Lewiston, ME 04240-3545 | 2007-07-24 |
| 1154549756 | Niagara Physical Therapy PC | Specialist | 736 Cayuga Street, Lewiston, NY 14092 | 2007-04-22 |
| 1154468775 | Daniel Raymond Miller | Specialist | 321 Skyline Dr, Lewiston, ID 83501-4220 | 2007-01-31 |
| 1811057458 | Joseph Wayne Flynn | Specialist | 12 Bates Street, Lewiston, ME 04240 | 2006-12-12 |
| 1174699730 | John Lindsey Williams | Specialist | 1850 Idaho St, Lewiston, ID 83501-2575 | 2006-11-27 |
| 1902902737 | Liliana C Saunero-nava | Specialist | 222 Southway Ave Ste C, Lewiston, ID 83501-2703 | 2006-09-16 |
| Find all providers in LEWISTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.