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General NPI Number Information
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NPI Number | 1669462602
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Entity Type | Organization
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Legal Business Name | MITCHELL HEALTHCARE ASSOCIATES
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3800 WOODWARD AVE STE 812
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City | DETROIT
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State | MI
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Zip | 48201-2061
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Country | US
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Telephone | 313-831-9269
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Fax | 313-831-9274
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Provider Business Mailing Address
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Address Line | 3800 WOODWARD AVE STE 812
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City | DETROIT
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State | MI
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Zip | 48201-2061
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Country | US
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Telephone | 313-831-9269
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Fax | 313-831-9274
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. PAMELA H STUART
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Credential |
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Telephone | 313-831-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901001869
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License Number State | MI
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