MEDICARE: MARK MITCHELL

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	207P00000X	Emergency Medicine Physician	49041	WY

General Provider Information

NPI Number	:	1215888045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MITCHELL

Provider Business Mailing Address
First Line	:	1821 BEAR CUB RD
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-9453
Country	:	US
Telephone Number	:	307-337-8058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 BEAR CUB RD
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82009-9453
Country	:	US
Telephone Number	:	307-337-8058
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ MARK MITCHELL ” Practice Location

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