Healthcare Provider Details

I. General information

NPI: 1194757310
Provider Name (Legal Business Name): LOU ANN MITCHELL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 305TH ST
TAMA IA
52339-9698
US

IV. Provider business mailing address

1646 305TH ST
TAMA IA
52339-9698
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-4094
  • Fax: 641-484-2432
Mailing address:
  • Phone: 641-484-4094
  • Fax: 641-484-2432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-05-7443-M
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24068
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: