Provider Demographics
NPI:1871926584
Name:MITCHELL, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3452
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48037-3452
Mailing Address - Country:US
Mailing Address - Phone:248-702-5551
Mailing Address - Fax:
Practice Address - Street 1:27620 FARMINGTON RD
Practice Address - Street 2:SUITE B2
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3349
Practice Address - Country:US
Practice Address - Phone:248-579-5814
Practice Address - Fax:877-678-3727
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No291U00000XLaboratoriesClinical Medical Laboratory