Individual
MARK WILLIAM MITTAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
RTE 12 BLDG 449, GROTON, CT 06349-5600
(860) 694-2377
(860) 694-2590
Mailing address
RTE 12 BLDG 449, ATTN: PROFESSIONAL AFFAIRS, GROTON, CT 06349-5600
(860) 694-2377
(860) 694-2590
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME48585
FL
Other
Enumeration date
11/02/2005
Last updated
06/03/2015
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