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NPI Code Detail

MEDICARE: JAMES B MITTON D.O.

MEDICARE: JAMES B MITTON D.O.
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
1207Q00000XFamily Medicine Physician5101006317MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922062108
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES B MITTON D.O.
Provider Business Mailing Address
First Line : 1925 BRETON RD SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-4810
Country : US
Telephone Number : 616-252-4765
Fax Number : 616-252-0127
Provider Business Practice Location Address
First Line : 7686 GEORGETOWN CENTER DR
Second Line :
City : JENISON
State : MI
Zip : 49428-8101
Country : US
Telephone Number : 616-252-4765
Fax Number : 616-252-0127
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/08/2007

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