Provider Demographics
NPI:1174505325
Name:MITCHELL, MICHELE M (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 746723
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6723
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:11260 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48214-3320
Practice Address - Country:US
Practice Address - Phone:313-749-0148
Practice Address - Fax:313-263-3298
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2020-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME88708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2140598Medicaid
GA20280I5275Medicare UPIN