Individual
DR. MICHAEL A MISTRETTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6600 W BROAD ST STE 300, RICHMOND, VA 23230-1709
(804) 320-4243
(804) 622-0552
Mailing address
1000 BOULDERS PKWY, SUITE 102, RICHMOND, VA 23225-5545
(804) 320-4243
(804) 282-1486
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
0101052617
VA
207RP1001X
Pulmonary Disease Physician
Primary
0101052617
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005812682
—
VA
01
—
021790
CIGNA PROVIDER NUMBER
VA
01
—
12178
CARENET PROVIDER NUMBER
VA
01
—
223643
ANTHEM
VA
01
—
4800040
UNITED HEALTHCARE PROV #
VA
01
—
557515
AETNA
VA
01
—
7044153
MAMSI PROVIDER NUMBER
VA
01
—
80057
SOUTHER HEALTH PROVIDER #
VA
Enumeration date
07/14/2006
Last updated
05/20/2021
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