Healthcare Provider Details

I. General information

NPI: 1962684811
Provider Name (Legal Business Name): MICHAEL ANTHONY MITCHEFF DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 N MERIDIAN ST
INDIANAPOLIS IN
46208-4348
US

IV. Provider business mailing address

6330 HARBOR DR
HUDSON FL
34667-1353
US

V. Phone/Fax

Practice location:
  • Phone: 317-294-4043
  • Fax:
Mailing address:
  • Phone: 727-514-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number02001040A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: