Provider Demographics
NPI:1811178254
Name:HOPE MITCHELL MD LLC
Entity type:Organization
Organization Name:HOPE MITCHELL MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-872-4673
Mailing Address - Street 1:815 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5255
Mailing Address - Country:US
Mailing Address - Phone:419-871-3737
Mailing Address - Fax:
Practice Address - Street 1:815 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5255
Practice Address - Country:US
Practice Address - Phone:419-871-3737
Practice Address - Fax:419-873-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845852OtherMEDICARE
OHP00212955OtherRAILROAD PTAN
OHH065730OtherMEDICARE
OHH107860OtherMEDICARE NUMBER
OHDD1846OtherRAILROAD MEDICARE
OHP00212955OtherRAILROAD PTAN