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NPI Code Detail

MEDICARE: KAMERON MITCHELL CPO

MEDICARE: KAMERON MITCHELL CPO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Z00000XOrthotist
2224P00000XProsthetist

General Provider Information

NPI Number : 1184449613
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAMERON MITCHELL CPO
Provider Business Mailing Address
First Line : 3236 COPPER HILL RUN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-3425
Country : US
Telephone Number : 320-333-6389
Fax Number :
Provider Business Practice Location Address
First Line : 5505 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7144
Country : US
Telephone Number : 317-522-6380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2024
Last Update Date : 11/19/2024

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Directions to “ KAMERON MITCHELL CPO” Practice Location

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