Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Clinzo P. Mickle II, MD

Individual provider Dermatology Physician · NPI 1104096361

Dr. Clinzo P. Mickle II, MD is a Dermatology in Washington, District of Columbia. Graduated from Medical University of South Carolina College of Medicine in 2002, 24 years ago. Practices with Integrated Dermatology of 19th Street LLC, a 5-clinician group and accepts Medicare assignment. Licensed in District of Columbia.

Years since qualifying
24
Trained at
Medical University of South Carolina College of Medicine
Licensed in
DC
In the registry since
2008
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

650 Pennsylvania Ave SE Ste 420
Washington, DC 20003-4318
Phone: (202) 547-9001
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dermatology Physician (primary) Taxonomy 207N00000X · Licence MD036757 (DC)

Record details

NPI number1104096361
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 4, 2008
Last updated in NPPESApril 6, 2011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyDERMATOLOGY
Medical schoolMEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduated 2002 (24 years in practice)
Group practice Integrated Dermatology Of 19th Street Llc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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