Provider Demographics
NPI:1265434849
Name:MITCHELL, DANIEL M (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1711 S STEPHENSON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3650
Mailing Address - Country:US
Mailing Address - Phone:906-774-1633
Mailing Address - Fax:906-774-4451
Practice Address - Street 1:1711 S STEPHENSON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3650
Practice Address - Country:US
Practice Address - Phone:906-774-1633
Practice Address - Fax:906-774-4451
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-09-29
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Provider Licenses
StateLicense IDTaxonomies
MI4301042600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30333700Medicaid
MI101686648Medicaid
MI080220008OtherBLUE CROSS BLUE SHIELD
080055774OtherRAILROAD MEDICARE
01007242OtherPREFERRED ONE
01007242OtherPREFERRED ONE
B43160Medicare UPIN