Individual
DR. RANDALL E MITCHEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5301 FARAON ST, SUITE 210, SAINT JOSEPH, MO 64506-3373
(816) 271-1385
(816) 271-1379
Mailing address
5301 FARAON ST STE 210A, SAINT JOSEPH, MO 64506-3512
(816) 271-1385
(816) 271-1379
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R6J49
MO
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
R6J49
MO
207RP1001X
Pulmonary Disease Physician
Primary
R6J49
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001363800
CHP
MO
05
—
100233020B
—
KS
05
—
205865009
—
MO
01
—
2104655
AETNA
MS
01
—
25862028
BLUE CROSS BLUE SHIELD KC
MO
01
—
403991
BLUE CROSS BLUE SHIELD KS
KS
Enumeration date
07/07/2006
Last updated
11/21/2017
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