Organization
MICHAEL S. MITNIK, M.D.,PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL SUMNER MITNIK M.D. (PRESIDENT)
(505) 893-2880
Entity
Organization
Contact information
Practice address
4801 MCMAHON BLVD NW, SUITE 155, ALBUQUERQUE, NM 87114-5090
(505) 893-2880
(505) 893-2886
Mailing address
4801 MCMAHON BLVD NW, SUITE 155, ALBUQUERQUE, NM 87114-5090
(505) 893-2880
(505) 893-2886
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
84223
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2124384
MEDICARE
NM
05
—
33589
—
NM
Enumeration date
08/25/2010
Last updated
08/25/2010
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