Provider Demographics
NPI:1194504837
Name:MITCHELL, MICHAEL K
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 SUMMER LANDING DR APT 206
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3816
Mailing Address - Country:US
Mailing Address - Phone:918-955-1485
Mailing Address - Fax:
Practice Address - Street 1:901 N BROAD ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5201
Practice Address - Country:US
Practice Address - Phone:706-291-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant