Provider Demographics
NPI:1902889371
Name:SHIRAH, MITCHELL CAREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:CAREY
Last Name:SHIRAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:59664 HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:AL
Mailing Address - Zip Code:36274-4438
Mailing Address - Country:US
Mailing Address - Phone:334-863-8952
Mailing Address - Fax:334-863-2361
Practice Address - Street 1:59664 HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:AL
Practice Address - Zip Code:36274-4438
Practice Address - Country:US
Practice Address - Phone:334-863-8952
Practice Address - Fax:334-863-2361
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000010937Medicaid
AL51525162OtherBCBS OF AL
P00181558OtherRAILROAD MEDICARE
000010937OtherMEDICARE
AL000010937Medicaid