Provider Demographics
NPI:1902391451
Name:MITHEN NEUROLOGY LLC
Entity Type:Organization
Organization Name:MITHEN NEUROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FANCIS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MITHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-308-7991
Mailing Address - Street 1:4579 LACLEDE AVE # 377
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2103
Mailing Address - Country:US
Mailing Address - Phone:314-308-7991
Mailing Address - Fax:314-462-0661
Practice Address - Street 1:3933 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4601
Practice Address - Country:US
Practice Address - Phone:314-308-7991
Practice Address - Fax:314-462-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR61522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty