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General NPI Number Information
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NPI Number | 1730351206
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Entity Type | Organization
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Legal Business Name | KEVIN MITCHELL MD PC
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 710 4TH ST SUITE B
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City | MARYSVILLE
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State | CA
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Zip | 95901-5668
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Country | US
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Telephone | 530-749-0700
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Fax | 530-749-9298
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Provider Business Mailing Address
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Address Line | 710 4TH ST SUITE B
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City | MARYSVILLE
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State | CA
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Zip | 95901-5668
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Country | US
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Telephone | 530-749-0700
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Fax | 530-749-9298
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Authorized Official
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Title or Position | SECRETARY
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Name | TERRELLE L.B. MITCHELL
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Credential |
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Telephone | 530-749-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | G867120
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License Number State | CA
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