Provider Demographics
NPI:1558342832
Name:MITCHEL, LEE S (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:S
Last Name:MITCHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 S EAST AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2329
Mailing Address - Country:US
Mailing Address - Phone:941-366-4015
Mailing Address - Fax:941-366-4125
Practice Address - Street 1:1217 S EAST AVE STE 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2329
Practice Address - Country:US
Practice Address - Phone:941-366-4015
Practice Address - Fax:941-366-4125
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51847207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275662500Medicaid
FL275662500Medicaid
FL25852AMedicare ID - Type Unspecified
FLF58587Medicare UPIN