1134428758 NPI number — DR. MITCHELL ANDREW PET MD

Table of content: DR. MITCHELL ANDREW PET MD (NPI 1134428758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134428758 NPI number — DR. MITCHELL ANDREW PET MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PET
Provider First Name:
MITCHELL
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134428758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7412011
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-2011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-362-7388
Provider Business Mailing Address Fax Number:
833-301-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BARNES JEWISH HOSPITAL PLZ
Provider Second Line Business Practice Location Address:
DIV SURG PLASTICS
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-362-7388
Provider Business Practice Location Address Fax Number:
833-301-0853
Provider Enumeration Date:
03/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  2018012226 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0122X , with the licence number: 2018012226 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200053721 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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