Provider Demographics
NPI:1073572012
Name:MITCHELL-FLYNN, DAVID LEE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:MITCHELL-FLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 DEERPATH PL
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-8836
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3922 DEERPATH PL
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-8836
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027043A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000076455OtherANTHEM PROVIDER NUMBER FOR URGENT CARE AT ARNETT CLINIC, LLC
IN000000766814OtherANTHEM PROVIDER NUMBER FOR FAMILY MEDICINE AT ARNETT CLINIC, LLC
IN100187400Medicaid
INMI57177011Medicaid
IN10825609OtherCAQH NUMBER
IN9397330OtherPHCS PID NUMBER
IN930061843Medicare PIN
IN000000766814OtherANTHEM PROVIDER NUMBER FOR FAMILY MEDICINE AT ARNETT CLINIC, LLC
IN10825609OtherCAQH NUMBER
INMI57177011Medicaid
IN9397330OtherPHCS PID NUMBER
IN815510IMedicare PIN