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NPI Code Detail

MEDICARE: MACY MITCHELL

MEDICARE: MACY 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1639025042
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACY MITCHELL
Provider Business Mailing Address
First Line : 414 BENSON AVE NE APT 1341
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-0047
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 15 MICHIGAN ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2508
Country : US
Telephone Number : 810-280-5899
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2026
Last Update Date : 03/09/2026

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Directions to “ MACY MITCHELL ” Practice Location

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