Provider Demographics
NPI:1235103961
Name:MITRICK, MICHAEL F (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:MITRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 POWDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-848-4800
Mailing Address - Fax:717-741-9867
Practice Address - Street 1:1750 5TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2607
Practice Address - Country:US
Practice Address - Phone:717-848-2297
Practice Address - Fax:717-848-2941
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004545L207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177124OtherHIGHMARK
PA202459OtherHEALTH AMERICA
PA03182100OtherCAPITAL BLUE CROSS
PACK4276OtherMEDICARE RR PALMETO GBA
PA177124OtherHIGHMARK
PA03182100OtherCAPITAL BLUE CROSS