PHILLIP LEE MICKELSEN MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036124588

License Status

NOT RENEWED

Business

Title

First Name

PHILLIP

Middle

LEE

Last Name

MICKELSEN

Business Name

PHILLIP LEE MICKELSEN MD

Original Issue Date

11/04/2009

Effective Date

06/20/2011

Expiration Date

07/31/2014

City

CHISHOLM

State

Zip

55719

Ever Disciplined

LastModifiedDate

11/17/2014