Healthcare Provider Details

I. General information

NPI: 1508858432
Provider Name (Legal Business Name): CASSIDY D MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S 16TH ST SUITE 430
LINCOLN NE
68502-3796
US

IV. Provider business mailing address

2222 S 16TH ST STE 400A
LINCOLN NE
68502-3796
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-8530
  • Fax: 402-483-8531
Mailing address:
  • Phone: 402-483-8590
  • Fax: 402-483-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number36164
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number24521
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: