Provider Demographics
NPI:1255384517
Name:MITCHEL, BRADLEY W (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:W
Last Name:MITCHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2034
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43603-2034
Mailing Address - Country:US
Mailing Address - Phone:440-233-8181
Mailing Address - Fax:440-233-8182
Practice Address - Street 1:6125 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3820
Practice Address - Country:US
Practice Address - Phone:440-233-8181
Practice Address - Fax:440-233-8182
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35082548M207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2555159Medicaid
OHI27474Medicare UPIN
OH2555159Medicaid