Provider Demographics
NPI:1093773459
Name:MITCHELL, STEPHEN BASIL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BASIL
Last Name:MITCHELL
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 1:234 MEDICAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1181
Mailing Address - Country:US
Mailing Address - Phone:606-784-6641
Mailing Address - Fax:606-783-7281
Practice Address - Street 1:234 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1181
Practice Address - Country:US
Practice Address - Phone:606-784-6641
Practice Address - Fax:606-780-2373
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000023034TOtherHUMANA - WS
KY100706OtherSIHO - WS
KY3691818000OtherPASSPORT ADVTG - WS
KY00533088OtherMEDICARE - WS
KY64264203Medicaid
KY50021524OtherPASSPORT - WS
KY000000601375OtherANTHEM - WS
IN200941190Medicaid
IN200941190Medicaid
KY100706OtherSIHO - WS