Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 162568 | NY |
NPI | 1114189115 |
---|---|
Provider Name | Dr. Michael D Mitchell |
First Address | Somers, NY 10541 |
Second Address | Somers, NY 10589-3222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 30/06/2008 |