MEDICARE: DR. CRAIG R. MITCHELL MD

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	207P00000X	Emergency Medicine Physician	ME102920	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

General Provider Information

NPI Number	:	1568424257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG R. MITCHELL MD

Provider Business Mailing Address
First Line	:	8390 CHAMPIONS GATE BLVD
Second Line	:	SUITE 306
City	:	CHAMPIONS GATE
State	:	FL
Zip	:	33896-8310
Country	:	US
Telephone Number	:	407-390-1677
Fax Number	:	407-390-1765

Provider Business Practice Location Address
First Line	:	8390 CHAMPIONS GATE BLVD
Second Line	:	SUITE 306
City	:	CHAMPIONS GATE
State	:	FL
Zip	:	33896-8310
Country	:	US
Telephone Number	:	407-390-1677
Fax Number	:	407-390-1765

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/04/2010

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