Provider Demographics
NPI:1225506652
Name:MITCHELL, MICHAEL TODD
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 DUNVEGAN CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-6089
Mailing Address - Country:US
Mailing Address - Phone:337-258-3826
Mailing Address - Fax:337-534-0412
Practice Address - Street 1:417 DUNVEGAN CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-6089
Practice Address - Country:US
Practice Address - Phone:337-258-3826
Practice Address - Fax:337-534-0412
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-03
Last Update Date:2018-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)