Healthcare Provider Details

I. General information

NPI: 1285160069
Provider Name (Legal Business Name): MITCHELL SEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10121 PINE AVE
TRUCKEE CA
96161-4856
US

IV. Provider business mailing address

18124 WEDGE PKWY # 953
RENO NV
89511-8134
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-6011
  • Fax:
Mailing address:
  • Phone: 530-305-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number56962
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20852
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR76284
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01097603A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: