Provider Demographics
NPI:1609861871
Name:MITCHELL, CHARLES F II (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:MITCHELL
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4897
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:5258 DIJON DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4311
Practice Address - Country:US
Practice Address - Phone:225-769-1090
Practice Address - Fax:225-769-4812
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2024-03-05
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Provider Licenses
StateLicense IDTaxonomies
LA012203207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190110Medicaid
LA1190110Medicaid
LAD04150Medicare UPIN