Basic Information
| Provider Information | |||||||||
| NPI: | 1871749127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL D. MITCHELL PHYSICIAN PC | ||||||||
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| OtherOrganizationName: | MICHAEL D. MITCHELL MD PC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 MAPLE STREET | ||||||||
| Address2: | PO BOX 41 | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147020041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164871124 | ||||||||
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| Practice Location | |||||||||
| Address1: | 207 FOOTE AVE | ||||||||
| Address2: | WCA HOSPITAL | ||||||||
| City: | JAMESTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 147017077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164871124 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2008 | ||||||||
| LastUpdateDate: | 08/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | MITCHELL | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 7164871124 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | 162887 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.