1043537020 NPI number — DR. EMILY A MITCHELL D.O.

Table of content: DR. EMILY A MITCHELL D.O. (NPI 1043537020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043537020 NPI number — DR. EMILY A MITCHELL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
EMILY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1043537020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 N SAINT JOSEPH AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NILES
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49120-2203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
42 N SAINT JOSEPH AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NILES
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49120-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-684-6696
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2010

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:  02004694A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: 5101018742 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PENDING , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1043537020 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com