LORIN MICKELSEN IV (NPI# 1689058356) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689058356 |
| Entity Type | Individual |
| Full Name | LORIN MICKELSEN IV |
| Credential | DPM |
| Practice Address |
4233 Gateway Blvd Newburgh IN 47630 |
| Mailing Address |
Po Box 1510 Evansville IN 47706-1510 |
| Practice Telephone | 8128585786 |
| Practice Fax Number | 8124904512 |
| Mailing Telephone | 8128585786 |
| Mailing Fax Number | 8124904512 |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2019-11-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 213E00000X | Podiatrist | 243967 | KY | Podiatric Medicine & Surgery Service Providers |
| Y | 213E00000X | Podiatrist | 07001281A | IN | Podiatric Medicine & Surgery Service Providers |
| N | 213ES0103X |
Podiatrist Specialization: Foot & Ankle Surgery |
00433 | KY | Podiatric Medicine & Surgery Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1300 Merritt Dr, Henderson, KY 424202788 | 2708270064 | 2708263338 |
| Street Address |
4233 GATEWAY BLVD |
| City | NEWBURGH |
| State | IN |
| Zip Code | 47630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982673661 | Ayaz Shaikh | Plastic Surgery | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2006-03-16 |
| 1346899465 | Rachel D Roy | Nurse Practitioner | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2019-09-11 |
| 1407335318 | Jessica L Conner | Nurse Practitioner | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2018-08-10 |
| 1619454188 | Erica R Thomason | Nurse Practitioner | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2018-07-26 |
| 1255875092 | Katherine L Waits | Nurse Practitioner | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2016-12-13 |
| 1629462635 | Tyler Tidwell | Podiatrist | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2015-03-27 |
| 1588083778 | Sally Elizabeth Vanwinkle | Physician Assistant | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2014-04-15 |
| 1003233263 | Gordon Brown | Family Medicine | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2014-03-26 |
| 1649534496 | Tanaporn Rasameesoraj | Psychiatry & Neurology | 4233 Gateway Blvd, Newburgh, IN 47630 | 2012-06-26 |
| 1811145832 | The Vision Care Center, LLC | Optometrist | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2008-09-03 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477199859 | Dana Marie Deken | Physical Therapy Assistant | 322 Bell Oaks, Newburgh, IN 47630 | 2019-11-21 |
| 1851948897 | Riley Elizabeth Eilken | Physical Therapist | 4233 Gateway Glbd, Suite 201, Newburgh, IN 47630 | 2019-08-23 |
| 1851851174 | Jennifer Ozete Cole | Physical Therapist | 4233 Gateway Boulvard Suite 201, Newburgh, IN 47630 | 2019-03-22 |
| 1174014542 | Katherine E Lyle | Music Therapist | 1003 Sr 662 W, Newburgh, IN 47630 | 2018-05-22 |
| 1144719923 | Jennifer Michelle Huffman | Occupational Therapy Assistant | 9800 Lincolne Avenue, Newburgh, IN 47630 | 2018-05-07 |
| 1215431846 | Deaconess Specialty Physicians, Inc | Internal Medicine | 4007 Gateway Blvd Ste 100, Newburgh, IN 47630 | 2018-03-20 |
| 1801313002 | Deaconess Hospital, Inc | Pharmacy | 4209 Gateway Blvd., Newburgh, IN 47630 | 2017-08-28 |
| 1629435599 | Caitlyn Beckinger | Physical Therapy Assistant | 9800 Lincoln Ave, Newburgh, IN 47630 | 2016-01-24 |
| 1568869410 | Jill Buck | Social Worker | 8788 Ruffian Ln Ste D, Newburgh, IN 47630 | 2014-11-20 |
| 1003191057 | Marshall Alan Cox | Pharmacist | 7769 Hwy 66, Newburgh, IN 47630 | 2011-10-20 |
| Find all providers in zip 47630 | ||||
| Taxonomy Code | 213E00000X |
| Grouping | Podiatric Medicine & Surgery Service Providers |
| Classification | Podiatrist |
| A podiatrist is a person qualified by a Doctor of Podiatric Medicine (D.P.M.) degree, licensed by the state, and practicing within the scope of that license. Podiatrists diagnose and treat foot diseases and deformities. They perform medical, surgical and other operative procedures, prescribe corrective devices and prescribe and administer drugs and physical therapy. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598961815 | Helene Linda Freer | Podiatrist | 8 Grimm Rd, Newburgh, NY 12550-2813 | 2007-06-23 |
| 1528040714 | Darin Richard Serletic | Podiatrist | 7580 Peachwood Dr, Newburgh, IN 47630-2693 | 2005-11-15 |
| 1124024732 | Drew Ames Richman | Podiatrist | 1418 Route 300, Ste 6, Newburgh, NY 12550-2994 | 2005-06-28 |
| 1730622945 | Patoka Valley Podiatry P.C. | Podiatrist | 7580 Peachwood Dr, Newburgh, IN 47630-2693 | 2016-11-21 |
| 1629462635 | Tyler Tidwell | Podiatrist | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2015-03-27 |
| 1477959898 | Ronald H Gomez | Podiatrist | 147 Lake St, Newburgh, NY 12550-5263 | 2014-11-12 |
| 1427368034 | Hudson Valley Total Podiatric Surgical Care, PC | Podiatrist | 54 N Plank Rd, Newburgh, NY 12550-2116 | 2010-10-15 |
| 1104154897 | Newburgh Podiatry Pllc | Podiatrist | 450 Gidney Ave, Suite 3, Newburgh, NY 12550-3116 | 2009-11-18 |
| 1972788255 | Warren Altwerger | Podiatrist | 450 Gidney Ave, Newburgh, NY 12550-3116 | 2008-01-04 |
| 1891861035 | Brandt L Dodson | Podiatrist | 4233 Gateway Blvd, Newburgh, IN 47630-8900 | 2006-11-28 |
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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.