License holder summary

MICHAEL R MICKELSON is a Board Of Medicine licensed to practice in Idaho. The address on file for MICHAEL R MICKELSON is 560 Memorial Dr Pocatello ID 83201. This licensed professional license is not current. The license was granted 10/24/1981 and expired on 08/01/2016.

Idaho

Division of Occupational and Professional Licenses

MICHAEL R MICKELSON
Board Of Medicine
License number
M-4397
Date granted
10/24/1981
Date expires
08/01/2016
Class
Board Of Medicine
Status
Canceled
Address
560 Memorial Dr Pocatello ID 83201
idaholicensing.com
ID 48354056
LAST UPDATED 2024-03-29 10:00:10 UTC

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