Individual
MITCHELL E F TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10517 MAPLE SPRINGS CV, FORT WAYNE, IN 46845-2132
(952) 595-1100
(612) 294-4903
Mailing address
3707 NEW VISION DR, FORT WAYNE, IN 46845-1702
(260) 373-4731
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01043985
IN
2085R0202X
Diagnostic Radiology Physician
1876
MN
2085R0202X
Diagnostic Radiology Physician
51163
TN
2085R0202X
Diagnostic Radiology Physician
MD60447306
WA
Other
Enumeration date
07/12/2006
Last updated
03/05/2021
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