MEDICARE: JUSTIN ADRIAN MITCHELL DO

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	R-13882	IA

General Provider Information

NPI Number	:	1255264560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN ADRIAN MITCHELL DO

Provider Business Mailing Address
First Line	:	1112 BYRON AVE
Second Line	:
City	:	WATERLOO
State	:	IA
Zip	:	50702-3131
Country	:	US
Telephone Number	:	309-453-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 PRAIRIE PKWY STE 205
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-8155
Country	:	US
Telephone Number	:	319-222-2711
Fax Number	:

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

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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