Provider Demographics
NPI:1285693796
Name:MITCHELL, MARIA L (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-1901
Mailing Address - Country:US
Mailing Address - Phone:515-262-0404
Mailing Address - Fax:515-262-0489
Practice Address - Street 1:2301 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-1901
Practice Address - Country:US
Practice Address - Phone:515-262-0404
Practice Address - Fax:515-262-0489
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080188604OtherRAILROAD MEDICARE NUMBER
IA1285693796Medicaid
IA6032268Medicaid
IA6032268Medicaid
IAA03721Medicare UPIN
IAI6856Medicare PIN