Healthcare Provider Details

I. General information

NPI: 1972583375
Provider Name (Legal Business Name): CHRISTOPHER MITCHELL PA C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 LANDERBROOK DR STE. 110
MAYFIELD HEIGHTS OH
44124-4039
US

IV. Provider business mailing address

5915 LANDERBROOK DR STE. 110 ALLERGY IMMUNOLOGY ASSOC., INC.
MAYFIELD HEIGHTS OH
44124-4039
US

V. Phone/Fax

Practice location:
  • Phone: 216-381-3333
  • Fax: 216-381-3002
Mailing address:
  • Phone: 216-381-3333
  • Fax: 216-381-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-002273RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: