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General NPI Number Information
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NPI Number | 1609808781
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Entity Type | Individual
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Provider Name | RANDALL E MITCHEM D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 11/21/2017
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Provider Practice Location Address
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Address Line | 5301 FARAON ST SUITE 210
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3373
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Country | US
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Telephone | 816-271-1385
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Fax | 816-271-1379
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Provider Business Mailing Address
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Address Line | 5301 FARAON ST STE 210A
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-3512
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Country | US
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Telephone | 816-271-1385
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Fax | 816-271-1379
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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 | R6J49
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | R6J49
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | R6J49
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License Number State | MO
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