Provider Demographics
NPI:1659377950
Name:CARL, MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:CARL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:520 TECHWOOD DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8500
Mailing Address - Country:US
Mailing Address - Phone:859-936-9844
Mailing Address - Fax:859-238-2206
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:STE 302
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8426
Practice Address - Country:US
Practice Address - Phone:606-528-5000
Practice Address - Fax:606-528-5113
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2013-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY37722207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611277847OtherCIGNA
KY64062292Medicaid
KY830008709OtherRAILROAD MEDICARE
KY000000769615OtherBCBS TROVER
KYP01079962OtherRR MEDICARE TROVER
KY7525437OtherAETNA
KYH61953OtherBLUEGRASS FAMILY HEALTH
KY000000290035OtherANTHEM BC/BS
KY500000606OtherPASSPORT
KY023379600OtherFEDERAL BLACK LUNG
KY611277847COtherHUMANA
KY611277847OtherCHA
KY87105OtherCOVENTRYCARES OF KENTUCKY
KY500000606OtherPASSPORT
KY64062292Medicaid
KY0510209Medicare PIN
KY0577907Medicare PIN
KY611277847COtherHUMANA
KY611277847OtherCHA
KY0546409Medicare PIN
KYK046081Medicare PIN
KY830008709OtherRAILROAD MEDICARE