Provider Demographics
NPI:1124281175
Name:MITCHELL, JASON W (MD, MPH, MBA)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:W
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD, MPH, MBA
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Mailing Address - Street 1:11995 SINGLETREE LN STE 500
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5349
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:11995 SINGLETREE LN STE 500
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5349
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1381212085R0204X, 2085R0202X
GA765472085R0204X
OH35.0959032085R0204X
IL036.1238842085R0204X
MDD00736312085R0204X
NJ25MA083381002085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology