MEDICARE: CASSIDY D 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
1	2086S0127X	Trauma Surgery Physician	36164	IA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	24521	NE

General Provider Information

NPI Number	:	1508858432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIDY D MITCHELL MD

Provider Business Mailing Address
First Line	:	2222 S 16TH ST
Second Line	:	STE 400A
City	:	LINCOLN
State	:	NE
Zip	:	68502-3796
Country	:	US
Telephone Number	:	402-483-8590
Fax Number	:	402-483-8599

Provider Business Practice Location Address
First Line	:	2222 S 16TH ST
Second Line	:	SUITE 430
City	:	LINCOLN
State	:	NE
Zip	:	68502-3796
Country	:	US
Telephone Number	:	402-483-8530
Fax Number	:	402-483-8531

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	12/01/2011

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Directions to “ CASSIDY D MITCHELL MD” Practice Location

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