Healthcare Provider Details

I. General information

NPI: 1588687354
Provider Name (Legal Business Name): MARC R MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 116TH AVE NE SUITE 200
BELLEVUE WA
98004-3819
US

IV. Provider business mailing address

PO BOX 5845
PORTLAND OR
97228-5845
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-5046
  • Fax: 425-454-6153
Mailing address:
  • Phone: 425-454-5281
  • Fax: 425-990-5261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00032904
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: