Provider Demographics
NPI:1144946831
Name:MITCHELL, MICHAEL KEITH
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEITH
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 BEVINGTON ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2221
Mailing Address - Country:US
Mailing Address - Phone:512-201-7187
Mailing Address - Fax:
Practice Address - Street 1:2405 BEVINGTON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2221
Practice Address - Country:US
Practice Address - Phone:512-201-7187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide