Provider Demographics
NPI:1942261094
Name:MITCHELL, ROBERT O (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 910670
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40591-0670
Mailing Address - Country:US
Mailing Address - Phone:859-971-4685
Mailing Address - Fax:859-971-4602
Practice Address - Street 1:1720 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 502
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1475
Practice Address - Country:US
Practice Address - Phone:859-277-7129
Practice Address - Fax:859-277-9613
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2020-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY26750208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64267503Medicaid
KY64267503Medicaid
KYK064460Medicare PIN
KYE01398Medicare UPIN