Provider Demographics
NPI:1508040502
Name:GHEN, MITCHELL J X (DO)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:J
Last Name:GHEN
Suffix:X
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 1:1167 HILLSBORO MILE APT 616F
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1618
Mailing Address - Country:US
Mailing Address - Phone:561-789-1588
Mailing Address - Fax:
Practice Address - Street 1:1167 HILLSBORO MILE APT 616F
Practice Address - Street 2:
Practice Address - City:HILLSBORO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1618
Practice Address - Country:US
Practice Address - Phone:561-789-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE32227Medicare UPIN