Individual
KELLY MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15194 21 MILE RD, TUSTIN, MI 49688-8545
(231) 829-3098
Mailing address
15194 21 MILE RD, TUSTIN, MI 49688-8545
(231) 829-3098
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
AF670015175
MI
Other
Enumeration date
12/19/2011
Last updated
12/19/2011
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