Provider Demographics
NPI:1083681845
Name:MITCHELL, MANCEL TALCOTT III (MD)
Entity Type:Individual
Prefix:MR
First Name:MANCEL
Middle Name:TALCOTT
Last Name:MITCHELL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:9201 W BROADWAY AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1924
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7066
Practice Address - Street 1:15655 37TH AVE N STE 100
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55446-4003
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-587-7701
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-11-08
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Provider Licenses
StateLicense IDTaxonomies
MN41686207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH00849Medicare UPIN