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

Mark D Miceli, MD

Individual provider Psychiatry Physician · NPI 1184658858

Mark D Miceli, MD is a Psychiatry in Coon Rapids, Minnesota. Graduated from Temple University School of Medicine in 2000, 26 years ago. Practices with Allina Health System, a 3,867-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota, Missouri, New Jersey and Wisconsin.

Years since qualifying
26
Trained at
Temple University School of Medicine
Licensed in
MN, MO, NJ, WI
In the registry since
2006
Specialties on file
4
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone: (612) 262-1220
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatry Physician (primary) Taxonomy 2084P0800X · Licence 64833 (MN)
Psychiatry Physician Taxonomy 2084P0800X · Licence 2017034370 (MO)
Psychiatry Physician Taxonomy 2084P0800X · Licence 25MA07643400 (NJ)
Psychiatry Physician Taxonomy 2084P0800X · Licence 308-320 (WI)

Record details

NPI number1184658858
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 10, 2006
Last updated in NPPESOctober 14, 2019
Mailing address114 W 7th St Ste 900, Austin, TX 78701-3013

Medicare enrollment

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

Medicare specialtyPSYCHIATRY
Medical schoolTEMPLE UNIVERSITY SCHOOL OF MEDICINE
Graduated 2000 (26 years in practice)
Group practice Allina Health System — 3867 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations10 on file with Medicare

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