Healthcare Provider Details

I. General information

NPI: 1700236452
Provider Name (Legal Business Name): MITCHEL CORDES MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/09/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC GROTON 1 WAHOO AVE
GROTON CT
06349
US

IV. Provider business mailing address

NAVAL HEALTH CLINIC GROTON 1 WAHOO AVE
GROTON CT
06349
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-4123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number62499
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number62499
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: