MEDICARE: KENNETH W. 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	207R00000X	Internal Medicine Physician	H0645	TX

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	:	1578522330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH W. MITCHELL MD

Provider Business Mailing Address
First Line	:	98 SAN JACINTO BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-4082
Country	:	US
Telephone Number	:	512-482-4115
Fax Number	:	512-482-4145

Provider Business Practice Location Address
First Line	:	98 SAN JACINTO BLVD STE 1800
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-4237
Country	:	US
Telephone Number	:	512-708-9700
Fax Number	:	512-482-4145

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	01/14/2025

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