Provider Demographics
NPI:1104922467
Name:MITCHELL, JAMES ROBERT (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8003
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8003
Mailing Address - Country:US
Mailing Address - Phone:920-996-3200
Mailing Address - Fax:920-725-6535
Practice Address - Street 1:1516 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4802
Practice Address - Country:US
Practice Address - Phone:920-725-0077
Practice Address - Fax:920-725-6535
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33095207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI450030843OtherMEDICARE PTAN
WI711290238OtherMEDICARE PTAN
WI31847700Medicaid
71420Medicare ID - Type Unspecified
WI711290238OtherMEDICARE PTAN