Provider Demographics
NPI:1023330214
Name:CARL V. MITTEN, D.O., P.A.
Entity type:Organization
Organization Name:CARL V. MITTEN, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:MITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-453-8531
Mailing Address - Street 1:310 FREEPORT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-2311
Mailing Address - Country:US
Mailing Address - Phone:713-453-8531
Mailing Address - Fax:713-453-1816
Practice Address - Street 1:310 FREEPORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-2311
Practice Address - Country:US
Practice Address - Phone:713-453-8531
Practice Address - Fax:713-453-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC9230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111737601Medicaid
TX8F23787OtherPTAN