Individual
DR. ROBERT H MITCHELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2347 W LINCOLN RD, KOKOMO, IN 46902-8012
(765) 455-4086
(765) 455-4078
Mailing address
2347 W LINCOLN RD, KOKOMO, IN 46902-8012
(765) 455-4086
(765) 455-4078
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01035052
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086375
BLUE SHIELD NUMBER
IN
01
—
01035052
STATE LICENSE NUMBER
IN
01
—
10784502
CAQH PROVIDER NUMBER
IN
Enumeration date
02/08/2006
Last updated
07/08/2007
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