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Individual

SHALENDER MITTAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
519 N 6TH ST, BLYTHEVILLE, AR 72315-2407
(870) 762-5800
(870) 762-5801
Mailing address
PO BOX 405, BLYTHEVILLE, AR 72316-0405
(870) 762-5800
(870) 762-5801

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
E2710
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
141358001
AR
05
161250002
AR
01
19103000000
QUALCHOICE
AR
01
5F529
BLUE CROSS
AR
01
9360340
PHCS
AR
01
DE9450
RAILROAD MEDICARE
AR
01
P00326909
RAILROAD MEDICARE
AR
Enumeration date
05/08/2006
Last updated
04/11/2022
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