Provider Demographics
NPI:1154471944
Name:MITCHELL, THOMAS SAMUEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SAMUEL
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:209 S SAN AGUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8581
Mailing Address - Country:US
Mailing Address - Phone:913-207-8830
Mailing Address - Fax:
Practice Address - Street 1:1150 N 75TH PL
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66112-2430
Practice Address - Country:US
Practice Address - Phone:913-299-1040
Practice Address - Fax:913-299-4205
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01476207P00000X
KS04-32272207Q00000X
KS94-06676207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSBM9842558OtherDEA NUMBER