Healthcare Provider Details

I. General information

NPI: 1942261094
Provider Name (Legal Business Name): ROBERT O MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NICHOLASVILLE RD SUITE 502
LEXINGTON KY
40503-1475
US

IV. Provider business mailing address

PO BOX 910670
LEXINGTON KY
40591-0670
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-7129
  • Fax: 859-277-9613
Mailing address:
  • Phone: 859-971-4685
  • Fax: 859-971-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number26750
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: