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General NPI Number Information
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NPI Number | 1922263573
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Entity Type | Organization
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Legal Business Name | KUNAL MITRA MD
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Dates
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Enumeration Date | 07/23/2008
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Last Update Date | 07/23/2008
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Provider Practice Location Address
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Address Line | 3575 RESERVE COMMONS DR SUITE 150
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City | MEDINA
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State | OH
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Zip | 44256
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Country | US
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Telephone | 330-725-7100
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Fax | 330-725-3084
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Provider Business Mailing Address
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Address Line | 3575 RESERVE COMMONS DR SUITE 150
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City | MEDINA
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State | OH
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Zip | 44256
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Country | US
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Telephone | 330-725-7100
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Fax | 330-725-3084
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Authorized Official
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Title or Position | OWNER
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Name | KUNAL MITRA
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Credential | MD
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Telephone | 330-725-7100
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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 | 35052774M
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License Number State | OH
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