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NPI Code Detail

MEDICARE: DR. VANESSA MONIQUE MITCHELL MD

MEDICARE: DR. VANESSA MONIQUE MITCHELL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianME151167FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033603899
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VANESSA MONIQUE MITCHELL MD
Provider Business Mailing Address
First Line : PO BOX 734951
Second Line :
City : CHICAGO
State : IL
Zip : 60673-4951
Country : US
Telephone Number : 702-899-0595
Fax Number : 702-977-1496
Provider Business Practice Location Address
First Line : 3487 NW 30TH ST
Second Line :
City : LAUDERDALE LAKES
State : FL
Zip : 33311-1103
Country : US
Telephone Number : 872-231-3162
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2018
Last Update Date : 11/14/2025

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