Healthcare Provider Details

I. General information

NPI: 1538689443
Provider Name (Legal Business Name): DANIEL JAMES MITCHELL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 S VAN BUREN ST
GREEN BAY WI
54301-3526
US

IV. Provider business mailing address

835 S VAN BUREN ST
GREEN BAY WI
54301-3526
US

V. Phone/Fax

Practice location:
  • Phone: 920-433-0111
  • Fax:
Mailing address:
  • Phone: 920-433-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.173303
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number81996-21
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: