Provider Demographics
NPI:1396747234
Name:MITCHELL, SHARON J (DO)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1209 10TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5262
Mailing Address - Country:US
Mailing Address - Phone:810-985-8170
Mailing Address - Fax:810-985-4660
Practice Address - Street 1:1209 10TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5262
Practice Address - Country:US
Practice Address - Phone:810-985-8170
Practice Address - Fax:810-985-4660
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3164660Medicaid
MI3164651Medicaid
MI3164660Medicaid
MI3164651Medicaid