Basic Information
| Provider Information | |||||||||
| NPI: | 1114189115 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 380 ROUTE 202 | ||||||||
| Address2: | |||||||||
| City: | SOMERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142775550 | ||||||||
| FaxNumber: | 9142775735 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 ROUTE 202 | ||||||||
| Address2: | |||||||||
| City: | SOMERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105893222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142775550 | ||||||||
| FaxNumber: | 9142775735 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 162568 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.