Provider Demographics
NPI:1386720571
Name:MITCHELL, MELANIE CAMILLE (MD)
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:CAMILLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8606 VILLAGE DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217
Mailing Address - Country:US
Mailing Address - Phone:210-657-0220
Mailing Address - Fax:210-590-7288
Practice Address - Street 1:525 OAK CENTRE
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-297-4560
Practice Address - Fax:210-297-0451
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK1880208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11662902Medicaid
TX11662902Medicaid
TX88078FMedicare ID - Type Unspecified