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NPI Code Detail

MEDICARE: BENNETT MITCHELL MD

MEDICARE: BENNETT 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
1207Q00000XFamily Medicine Physician7323NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639140205
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENNETT MITCHELL MD
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-877-5199
Fax Number : 702-259-0128
Provider Business Practice Location Address
First Line : 540 N NELLIS BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89110-5368
Country : US
Telephone Number :
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 11/18/2024

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Directions to “ BENNETT MITCHELL MD” Practice Location

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