Healthcare Provider Details

I. General information

NPI: 1275597114
Provider Name (Legal Business Name): MITCHELL CHRISTOPHER STICKLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 KINGS HIGHWAY STE 110
LEWES DE
19958
US

IV. Provider business mailing address

750 KINGS HIGHWAY STE 110
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-6400
  • Fax: 302-644-6409
Mailing address:
  • Phone: 302-644-6400
  • Fax: 302-644-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC10003715
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberC1-0003715
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberC1-0003715
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: