Provider Demographics
NPI:1114964095
Name:LEE S MITCHEL MD PA
Entity Type:Organization
Organization Name:LEE S MITCHEL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-366-4015
Mailing Address - Street 1:1219 EAST AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2348
Mailing Address - Country:US
Mailing Address - Phone:941-366-4015
Mailing Address - Fax:941-366-4125
Practice Address - Street 1:1219 EAST AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2348
Practice Address - Country:US
Practice Address - Phone:941-366-4015
Practice Address - Fax:941-366-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51847207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6534Medicare ID - Type Unspecified