Organization
LAKE TYE EMERGENCY PHYSICIANS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES MITCHELL MD (PRESIDENT)
(469) 401-2386
Entity
Organization
Contact information
Practice address
14701 179TH AVE SE, MONROE, WA 98272-1108
(360) 794-7497
Mailing address
13737 NOEL RD, STE 1600, DALLAS, TX 75240-1331
(469) 401-2386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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