Healthcare Provider Details

I. General information

NPI: 1265434849
Provider Name (Legal Business Name): DANIEL M MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S STEPHENSON AVE SUITE 300
IRON MOUNTAIN MI
49801-3650
US

IV. Provider business mailing address

1711 S STEPHENSON AVE SUITE 300
IRON MOUNTAIN MI
49801-3650
US

V. Phone/Fax

Practice location:
  • Phone: 906-774-1633
  • Fax: 906-774-4451
Mailing address:
  • Phone: 906-774-1633
  • Fax: 906-774-4451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301042600
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: