MEDICARE: DR. CAROL 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	207R00000X	Internal Medicine Physician	25327	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1710986310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL MITCHELL MD

Provider Business Mailing Address
First Line	:	496 SOUTHLAND DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1827
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-288-7510

Provider Business Practice Location Address
First Line	:	1640 BRYAN STATION RD STE 1
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40505-2144
Country	:	US
Telephone Number	:	859-288-2425
Fax Number	:	859-721-3918

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/20/2019

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