Provider Demographics
NPI:1861837783
Name:DURANTE, MITCHELL JOSEPH THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:JOSEPH THOMAS
Last Name:DURANTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0449
Mailing Address - Country:US
Mailing Address - Phone:800-345-5407
Mailing Address - Fax:636-386-5386
Practice Address - Street 1:11133 DUNN RD STE 2427
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6163
Practice Address - Country:US
Practice Address - Phone:314-653-5643
Practice Address - Fax:314-653-5648
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020406207R00000X
MO2017008334208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine