Provider Demographics
NPI:1417145913
Name:MITCHELL, SHARON (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2762
Mailing Address - Country:US
Mailing Address - Phone:620-624-0604
Mailing Address - Fax:620-624-1148
Practice Address - Street 1:13 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2762
Practice Address - Country:US
Practice Address - Phone:620-624-0604
Practice Address - Fax:620-624-1148
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0427259173000000X, 207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No173000000XOther Service ProvidersLegal Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100572Medicare PIN