Provider Demographics
NPI:1790081651
Name:MICHAEL A MITCHELL DO, PLLC
Entity Type:Organization
Organization Name:MICHAEL A MITCHELL DO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:940-538-0245
Mailing Address - Street 1:100 SOUTH ARCHER ST.
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:TX
Mailing Address - Zip Code:76365
Mailing Address - Country:US
Mailing Address - Phone:940-538-0245
Mailing Address - Fax:940-538-0317
Practice Address - Street 1:100 SOUTH ARCHER ST.
Practice Address - Street 2:
Practice Address - City:HENRIETTA
Practice Address - State:TX
Practice Address - Zip Code:76365
Practice Address - Country:US
Practice Address - Phone:940-538-0245
Practice Address - Fax:940-538-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty