Provider Demographics
NPI:1134351190
Name:TONG-MITCHELL, NICOLE WING CHEE (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:WING CHEE
Last Name:TONG-MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:WING CHEE
Other - Last Name:TONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:221 N KANSAS ST
Mailing Address - Street 2:STE. 1501
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79901-1443
Mailing Address - Country:US
Mailing Address - Phone:915-546-9200
Mailing Address - Fax:915-546-9800
Practice Address - Street 1:221 N KANSAS ST
Practice Address - Street 2:STE. 1501
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79901-1443
Practice Address - Country:US
Practice Address - Phone:915-546-9200
Practice Address - Fax:915-546-9800
Is Sole Proprietor?:No
Enumeration Date:2009-08-10
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT013615207R00000X
MI5101018207208D00000X
TXP7863207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM81359811Medicaid
TXP01261172OtherRAILROAD RETIREMENT MEDICARE
TX331777801Medicaid
NM81359811Medicaid