Healthcare Provider Details

I. General information

NPI: 1922062108
Provider Name (Legal Business Name): JAMES B MITTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7686 GEORGETOWN CENTER DR
JENISON MI
49428-8101
US

IV. Provider business mailing address

1925 BRETON RD SE
GRAND RAPIDS MI
49506-4810
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-4765
  • Fax: 616-252-0127
Mailing address:
  • Phone: 616-252-4765
  • Fax: 616-252-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101006317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: