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NPI Code Detail

MEDICARE: MARK ANTHONY MITCHELL MSW

MEDICARE: MARK ANTHONY MITCHELL MSW
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
1104100000XSocial Worker6801084841MI

General Provider Information

NPI Number : 1053364307
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ANTHONY MITCHELL MSW
Provider Business Mailing Address
First Line : 279 SUMMIT DR
Second Line :
City : WATERFORD
State : MI
Zip : 48328-3364
Country : US
Telephone Number : 248-745-4900
Fax Number :
Provider Business Practice Location Address
First Line : 279 SUMMIT DR
Second Line :
City : WATERFORD
State : MI
Zip : 48328-3364
Country : US
Telephone Number : 248-745-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2006
Last Update Date : 05/16/2008

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