Provider Demographics
NPI:1669462602
Name:MITCHELL HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:MITCHELL HEALTHCARE ASSOCIATES
Other - Org Name:KENNETH MITCHELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-831-9264
Mailing Address - Street 1:3800 WOODWARD AVE
Mailing Address - Street 2:STE 812
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2061
Mailing Address - Country:US
Mailing Address - Phone:313-831-9269
Mailing Address - Fax:313-831-9274
Practice Address - Street 1:3800 WOODWARD AVE
Practice Address - Street 2:STE 812
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2061
Practice Address - Country:US
Practice Address - Phone:313-831-9269
Practice Address - Fax:313-831-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001869213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKM001869OtherBCBSM
3507405OtherMOLINA
MI3507405Medicaid
U73049Medicare UPIN
OM72840Medicare ID - Type Unspecified