Healthcare Provider Details

I. General information

NPI: 1295050060
Provider Name (Legal Business Name): RYAN MICHAEL MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 110
DENVER CO
80205-5504
US

IV. Provider business mailing address

2055 N HIGH ST STE 110
DENVER CO
80205-5504
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-8620
  • Fax:
Mailing address:
  • Phone: 303-301-9019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01078298A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0065156
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: