Provider Demographics
NPI:1902887037
Name:MITCHELL, ANDRE L (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:L
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 N KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-8562
Mailing Address - Country:US
Mailing Address - Phone:763-438-3554
Mailing Address - Fax:
Practice Address - Street 1:9314 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64157-8562
Practice Address - Country:US
Practice Address - Phone:763-438-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016040628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
132962OtherU CARE
1043859OtherPREFERRED ONE
2400184OtherMEDICA HEALTH PLANS
FAC#498RICEOtherBLUE CROSS BLUE SHIELD
386K5MIOtherBLUE CROSS BLUE SHIELD
2366396OtherARAZ GROUP AMERICAS PPO
HP53834OtherHEALTH PARTNERS
716123900OtherMEDICAL ASSISTANCE
I20215Medicare UPIN