Provider Demographics
NPI:1770573420
Name:MITCHELL, PAUL J (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-252-5131
Mailing Address - Fax:320-240-2118
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-252-5131
Practice Address - Fax:320-240-2118
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00T48MIOtherBLUE CROSS BLUE SHIELD
1008560OtherPREFERRED ONE
2114023OtherFIRST HEALTH PLAN
110926OtherU-CARE
1701041OtherMEDICA HEALTH PLANS
357714700OtherMEDICAL ASSISTANCE (MA)
HP25487OtherHEALTH PARTNERS
600898OtherARAZ GROUP/AMERICA'S PPO
2114023OtherFIRST HEALTH PLAN
110926OtherU-CARE