Provider Demographics
NPI:1508858432
Name:MITCHELL, CASSIDY D (MD)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:D
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2222 S 16TH ST
Mailing Address - Street 2:STE 400A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3796
Mailing Address - Country:US
Mailing Address - Phone:402-483-8590
Mailing Address - Fax:402-483-8599
Practice Address - Street 1:2222 S 16TH ST
Practice Address - Street 2:SUITE 430
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3796
Practice Address - Country:US
Practice Address - Phone:402-483-8530
Practice Address - Fax:402-483-8531
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA361642086S0127X
NE245212086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
I34353Medicare UPIN