Provider Demographics
NPI:1568432532
Name:GALISHOFF, MITCHEL LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHEL
Middle Name:LEWIS
Last Name:GALISHOFF
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 1:21 MEDICAL PARK
Mailing Address - Street 2:VALLEY MEDICAL SURGICAL CLINIC
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-3665
Mailing Address - Country:US
Mailing Address - Phone:334-756-4156
Mailing Address - Fax:334-756-8181
Practice Address - Street 1:21 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-3665
Practice Address - Country:US
Practice Address - Phone:334-756-4156
Practice Address - Fax:334-756-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17338207R00000X
GA043619207R00000X
VA0101043335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000594382AMedicaid
AL529202520Medicaid
GA000594382AMedicaid
F22911Medicare UPIN