Provider Demographics
NPI:1316147572
Name:MITCHELL, JOHN B (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1000 PARCHMENT DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-3663
Mailing Address - Country:US
Mailing Address - Phone:215-746-7222
Mailing Address - Fax:
Practice Address - Street 1:555 MID TOWNE ST NE
Practice Address - Street 2:STE 304
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503
Practice Address - Country:US
Practice Address - Phone:215-746-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT1846752084P0800X
MI43010953352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry