MEDICARE: DR. MICHAEL J 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	208600000X	Surgery Physician	1918411	NY
2	2086S0129X	Vascular Surgery Physician	1918411	NY
3	208600000X	Surgery Physician	89809	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	G27040	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0198192	OTHER	GHI
2	203107077	OTHER	UNITED HEALTHCARE
3	203107077	OTHER	TRICARE/CHAMPUS
4	203107077	OTHER	NA ADMINISTRATORS
5	00524182003	OTHER	BLUE SHIELD/BLUE CROSS
6	203107077	OTHER	CIGNA
7	203107077	OTHER	AETNA
9	1708059	OTHER	INDEPENDENT HEALTH
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750371746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J MITCHELL MD

Provider Business Mailing Address
First Line	:	506 E CHEVES ST STE 202
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2616
Country	:	US
Telephone Number	:	843-716-8940
Fax Number	:	843-716-9760

Provider Business Practice Location Address
First Line	:	3112 CASEY ST
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2857
Country	:	US
Telephone Number	:	843-716-8940
Fax Number	:	843-716-9760

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	08/29/2023

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Directions to “ DR. MICHAEL J MITCHELL MD” Practice Location

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