Provider Demographics
NPI:1497740740
Name:MITAL, SATISH CHAND (MD)
Entity Type:Individual
Prefix:
First Name:SATISH
Middle Name:CHAND
Last Name:MITAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4646
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-216-0101
Practice Address - Street 1:1300 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4646
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-216-0101
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00000OtherUNIVERSAL HEALTH CARE
FL00000OtherHUMANA/CHOICE CARE
GA00000OtherBEECH STREET/CAPP CARE
FL00000OtherEVOLUTIONS
FL00000OtherUNITED HEALTH CARE
FL42844OtherBCBS
FL00000OtherMAX CARE
FL00000OtherMULTIPLAN
FL00000OtherSOUTHCARE
FL258817000Medicaid
FLSG058336OtherVISTA
FL00000OtherHUMANA/CHOICE CARE
FL00000OtherMAX CARE
G65108Medicare UPIN