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General NPI Number Information
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NPI Number | 1710097019
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Entity Type | Individual
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Provider Name | CONNIE L MITCHELL MD
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 5525 GREENWAY ST UNIT B-2
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City | DETROIT
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State | MI
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Zip | 48204-2112
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Country | US
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Telephone | 313-701-1187
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Fax | 313-931-9113
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Provider Business Mailing Address
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Address Line | 5525 GREENWAY ST UNIT B-2
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City | DETROIT
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State | MI
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Zip | 48204-2112
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Country | US
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Telephone | 313-701-1187
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Fax | 313-931-9113
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | M4301056553
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License Number State | MI
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