Provider Demographics
NPI:1194757310
Name:MITCHELL, LOU ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LOU
Middle Name:ANN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 305TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-9698
Mailing Address - Country:US
Mailing Address - Phone:641-484-4094
Mailing Address - Fax:641-484-2432
Practice Address - Street 1:1646 305TH ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9698
Practice Address - Country:US
Practice Address - Phone:641-484-4094
Practice Address - Fax:641-484-2432
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-7443-M207Q00000X
IA24068207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC03403Medicare UPIN