MEDICARE: DR. KIA MICHON MITCHELL M.D.

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
1	207Q00000X	Family Medicine Physician	ME94137	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	29405	OTHER	FL	FL BLUE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184602583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIA MICHON MITCHELL M.D.

Provider Business Mailing Address
First Line	:	12086 FORT CAROLINE RD STE 401
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-7640
Country	:	US
Telephone Number	:	904-565-1271
Fax Number	:	904-683-6884

Provider Business Practice Location Address
First Line	:	12086 FORT CAROLINE RD
Second Line	:	STE 401
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-2687
Country	:	US
Telephone Number	:	904-565-1271
Fax Number	:	904-645-7325

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2006
Last Update Date	:	06/22/2019

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