Provider Demographics
NPI:1700918802
Name:MITCHEFF, CLIFFORD A (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:A
Last Name:MITCHEFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CURRY PIKE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2593
Mailing Address - Country:US
Mailing Address - Phone:812-339-9980
Mailing Address - Fax:812-349-4007
Practice Address - Street 1:100 N CURRY PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2593
Practice Address - Country:US
Practice Address - Phone:812-339-9980
Practice Address - Fax:812-349-4007
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002934A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN090200JMedicare ID - Type Unspecified
INI48061Medicare UPIN