Individual
REI MITSUYAMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-4741
Mailing address
110 ELM ST, PROVIDENCE, RI 02903-4626
(401) 443-4992
(401) 537-7241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
LP04836
RI
207R00000X
Internal Medicine Physician
Primary
MD19179
RI
Other
Enumeration date
05/18/2020
Last updated
05/01/2023
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