Provider Demographics
NPI:1447241864
Name:MITCHELL, E PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:PATRICK
Last Name:MITCHELL
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 1:1 WILLIAM CARLS DR
Mailing Address - Street 2:RSC
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2201
Mailing Address - Country:US
Mailing Address - Phone:248-937-4947
Mailing Address - Fax:248-937-5150
Practice Address - Street 1:1 WILLIAM CARLS DR
Practice Address - Street 2:RSC
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2201
Practice Address - Country:US
Practice Address - Phone:248-937-4947
Practice Address - Fax:248-937-5150
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007550207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101007550OtherMI STATE LICENSE
MI132620OtherCARE CHOICES/PREFERRED CH
MI5606110003OtherADMINISTAR FED DME HARTLAND
MIC6758OtherMCARE
MI2056300195OtherBCBSM PIN #
MI3515784 TYPE 11Medicaid
MI4274992OtherAETNA
MI5606110001OtherADMINISTAR FED DME RSC
MI5606110001OtherADMINISTAR FED DME RSC
MI132620OtherCARE CHOICES/PREFERRED CH