Individual
KENNETH R MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
611 1ST AVE, CHIPPEWA FALLS, WI 54729-1242
(715) 838-5222
Mailing address
PO BOX 1510, EAU CLAIRE, WI 54702-1510
(715) 838-5222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31357
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31706600
—
WI
Enumeration date
07/03/2006
Last updated
07/08/2007
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