Provider Demographics
NPI:1912015751
Name:MITCHELL, HOWARD LARRY (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:LARRY
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:770 N COTNER BLVD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2310
Mailing Address - Country:US
Mailing Address - Phone:402-441-3400
Mailing Address - Fax:402-441-3430
Practice Address - Street 1:770 N COTNER BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2310
Practice Address - Country:US
Practice Address - Phone:402-441-3400
Practice Address - Fax:402-441-3430
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE20551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07224OtherBCBS OF NE
271589Medicare ID - Type Unspecified
0400413OtherUNITED HEALTHCARE
H07567Medicare UPIN