Provider Demographics
NPI:1174589956
Name:UNTRACHT, MITCHELL S (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:S
Last Name:UNTRACHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 SE MONTEREY COMMONS BLVD
Mailing Address - Street 2:#201
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:#4000
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-833-0882
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54051207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61772Medicare UPIN