Provider Demographics
NPI:1235743477
Name:MITCHELL, WARREN EDWARD
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:EDWARD
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 1:4172 E 106TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-5309
Mailing Address - Country:US
Mailing Address - Phone:216-970-6277
Mailing Address - Fax:
Practice Address - Street 1:4172 E 106TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-5309
Practice Address - Country:US
Practice Address - Phone:216-970-6277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty