Healthcare Provider Details

I. General information

NPI: 1790081651
Provider Name (Legal Business Name): MICHAEL A MITCHELL DO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ARCHER ST.
HENRIETTA TX
76365
US

IV. Provider business mailing address

100 SOUTH ARCHER ST.
HENRIETTA TX
76365
US

V. Phone/Fax

Practice location:
  • Phone: 940-538-0245
  • Fax: 940-538-0317
Mailing address:
  • Phone: 940-538-0245
  • Fax: 940-538-0317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A MITCHELL
Title or Position: OWNER/MEMBER
Credential: D.O.
Phone: 940-538-0245