Provider Demographics
NPI:1205031036
Name:MITCHELL, ERIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1045 GEZON PKWY SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-9542
Mailing Address - Country:US
Mailing Address - Phone:616-456-5311
Mailing Address - Fax:616-456-7955
Practice Address - Street 1:1045 GEZON PKWY SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509
Practice Address - Country:US
Practice Address - Phone:616-456-5311
Practice Address - Fax:616-456-7955
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2018-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301090380208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery