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General NPI Number Information
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NPI Number | 1578522330
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Entity Type | Individual
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Provider Name | KENNETH W. MITCHELL MD
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 98 SAN JACINTO BLVD STE 1800
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City | AUSTIN
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State | TX
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Zip | 78701-4237
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Country | US
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Telephone | 512-708-9700
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Fax | 512-482-4145
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Provider Business Mailing Address
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Address Line | 98 SAN JACINTO BLVD
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City | AUSTIN
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State | TX
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Zip | 78701-4082
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Country | US
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Telephone | 512-482-4115
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Fax | 512-482-4145
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | H0645
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License Number State | TX
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