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General NPI Number Information
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NPI Number | 1881045748
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Entity Type | Individual
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Provider Name | PETER NATHANAEL MITTWEDE M.D., PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 401 BAPTIST DR STE 301
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City | MADISON
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State | MS
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Zip | 39110-2012
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Country | US
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Telephone | 601-973-1571
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Fax | 601-973-1577
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 315
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City | MEMPHIS
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State | TN
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Zip | 38120-9401
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Country | US
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Telephone | 877-348-1281
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Fax | 901-227-3206
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD469401
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License Number State | PA
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