Provider Demographics
NPI:1447288618
Name:MITCHELL, LILLIAN A (MD)
Entity type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7826 SW 60 AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6426
Mailing Address - Country:US
Mailing Address - Phone:352-873-7600
Mailing Address - Fax:352-873-6802
Practice Address - Street 1:7826 SW 6O AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6426
Practice Address - Country:US
Practice Address - Phone:352-873-7600
Practice Address - Fax:352-873-6802
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76394207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL255273600Medicaid
G10359Medicare UPIN
FL255273600Medicaid