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General NPI Number Information
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NPI Number | 1134511041
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Entity Type | Organization
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Legal Business Name | DR. CORDELL MITCHELL
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Dates
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Enumeration Date | 03/02/2015
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Last Update Date | 03/02/2015
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Provider Practice Location Address
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Address Line | 974 DOUGLAS AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-5203
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Country | US
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Telephone | 407-862-1550
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Fax | 407-862-6042
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Provider Business Mailing Address
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Address Line | 974 DOUGLAS AVE
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-5203
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Country | US
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Telephone | 407-862-1550
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Fax | 407-862-6042
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CORDELL MITCHELL
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Credential | M.D.
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Telephone | 407-862-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME53063
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License Number State | FL
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