=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154340602
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAX MITCHELL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2006
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2055 N HIGH ST STE 260
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80205-5575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-475-8730
-----------------------------------------------------
Fax | 303-832-7297
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2055 N HIGH ST STE 260
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80205-5575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-475-8730
-----------------------------------------------------
Fax | 303-832-7297
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 31202
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------