Healthcare Provider Details

I. General information

NPI: 1952669152
Provider Name (Legal Business Name): JOSEPH LEE MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13025 WELLINGTON WAY
GOSHEN KY
40026-8440
US

IV. Provider business mailing address

13025 WELLINGTON WAY
GOSHEN KY
40026-8440
US

V. Phone/Fax

Practice location:
  • Phone: 270-391-0697
  • Fax: 270-249-4086
Mailing address:
  • Phone: 270-391-0697
  • Fax: 270-249-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number48295
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48295
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: