Provider Demographics
NPI:1578522330
Name:MITCHELL, KENNETH W (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:W
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:98 SAN JACINTO BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4082
Mailing Address - Country:US
Mailing Address - Phone:512-482-4115
Mailing Address - Fax:512-482-4145
Practice Address - Street 1:98 SAN JACINTO BLVD STE 1800
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-4237
Practice Address - Country:US
Practice Address - Phone:512-708-9700
Practice Address - Fax:512-482-4145
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123748903Medicaid
TX123748903Medicaid
TXB95682Medicare UPIN