MEDICARE: DR. MITCHELL J GHEN X D.O.

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	207Q00000X	Family Medicine Physician	OS4280	FL

General Provider Information

NPI Number	:	1508040502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL J GHEN X D.O.

Provider Business Mailing Address
First Line	:	1167 HILLSBORO MILE APT 616F
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-1618
Country	:	US
Telephone Number	:	561-789-1588
Fax Number	:

Provider Business Practice Location Address
First Line	:	1167 HILLSBORO MILE APT 616F
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-1618
Country	:	US
Telephone Number	:	561-789-1588
Fax Number	:

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

Provider Enumeration Date	:	12/27/2007
Last Update Date	:	12/27/2007

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