Provider Demographics
NPI:1053121657
Name:MITCHELL, MELVIN DARON
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:DARON
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40311 W HELEN CT
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5169
Mailing Address - Country:US
Mailing Address - Phone:414-915-8497
Mailing Address - Fax:
Practice Address - Street 1:40311 W HELEN CT
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5169
Practice Address - Country:US
Practice Address - Phone:414-915-8497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD07899652172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver