Provider Demographics
NPI:1205219680
Name:LIND, MITCHELL J (PA-C)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:LIND
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3059 VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8303
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7229
Practice Address - Street 1:1630 COMMANCHE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-5753
Practice Address - Country:US
Practice Address - Phone:920-430-4700
Practice Address - Fax:920-430-4747
Is Sole Proprietor?:No
Enumeration Date:2015-07-03
Last Update Date:2021-10-17
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Provider Licenses
StateLicense IDTaxonomies
WI3610-23363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical