1881926343 NPI number — DR. ELLIOT JONATHAN MITMAKER MD

Table of content: DR. ELLIOT JONATHAN MITMAKER MD (NPI 1881926343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881926343 NPI number — DR. ELLIOT JONATHAN MITMAKER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITMAKER
Provider First Name:
ELLIOT
Provider Middle Name:
JONATHAN
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:
1881926343
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 DIVISADERO ST # 1674
Provider Second Line Business Mailing Address:
HELLMAN BUILDING RM. C-349
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94115-3010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-885-7616
Provider Business Mailing Address Fax Number:
415-885-7617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 DIVISADERO ST
Provider Second Line Business Practice Location Address:
MT ZION HOSPITAL, 3RD FLOOR
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94115-3066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-353-7789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2010

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:  A106601 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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