Provider Demographics
NPI:1578522330
Name:MITCHELL, KENNETH W (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12221 MOPAC EXPRESSWAY NORTH
Mailing Address - Street 2:NORTH AUSTIN MEDICAL CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2496
Mailing Address - Country:US
Mailing Address - Phone:512-901-2500
Mailing Address - Fax:512-901-1998
Practice Address - Street 1:6101 BALCONES DR
Practice Address - Street 2:SUITE #300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4231
Practice Address - Country:US
Practice Address - Phone:512-482-0045
Practice Address - Fax:512-476-9892
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXH0645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123748903Medicaid
TX123748903Medicaid
TXB95682Medicare UPIN