Provider Demographics
NPI:1750371746
Name:MITCHELL, MICHAEL J (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MITCHELL
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 1:506 E CHEVES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2616
Mailing Address - Country:US
Mailing Address - Phone:843-716-8940
Mailing Address - Fax:843-716-9760
Practice Address - Street 1:3112 CASEY ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-2857
Practice Address - Country:US
Practice Address - Phone:843-716-8940
Practice Address - Fax:843-716-9760
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1918411208600000X, 2086S0129X
SC89809208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0198192OtherGHI
203107077OtherUNITED HEALTHCARE
203107077OtherTRICARE/CHAMPUS
203107077OtherNA ADMINISTRATORS
00524182003OtherBLUE SHIELD/BLUE CROSS
203107077OtherCIGNA
203107077OtherAETNA
G27040OtherMEDICARE RAILROAD
1708059OtherINDEPENDENT HEALTH
NY01669992Medicaid