Individual
MICHAEL SHANE MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
5371 WASHINGTON ST, CAMP LEJEUNE, NC 28547-1104
(843) 640-2075
Mailing address
5371 WASHINGTON ST, CAMP LEJEUNE, NC 28547-1104
(843) 640-2075
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/11/2013
Last updated
04/11/2013
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