MEDICARE: MITCHELL DALVIN D.P.M.

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	36 002104	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1073511473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL DALVIN D.P.M.

Provider Business Mailing Address
First Line	:	1749 S RACCOON RD
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-4703
Country	:	US
Telephone Number	:	330-799-3383
Fax Number	:	330-799-3505

Provider Business Practice Location Address
First Line	:	1749 S RACCOON RD
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-4703
Country	:	US
Telephone Number	:	330-799-3383
Fax Number	:	330-799-3505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	02/12/2008

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