Active NPI
Lawrence C. Mitchell, M.D.
- Internal Medicine Physician
- West Bloomfield, MI
National Provider Identifier
1255409702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 039076
- Practice address
- Henry Ford Health System
6777 West Maple Road
West Bloomfield, MI 48323 - Phone
- (248) 661-6450
- Fax
- (248) 661-6649
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 039076 | MI | Primary |
Addresses
Primary practice location
Henry Ford Health System
6777 West Maple Road
West Bloomfield, MI 48323
Mailing address
2520 S Telegraph Road
Henry Ford Health System
Bloomfield Hills, MI 48330
Phone (248) 451-6001
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 700H262220 | Other | BLUE CROSS-BLUE CROSS | |
| LM039076 | Other | COMMERCIAL-COMMERCIAL NUMBER | |
| 137335810 | Medicaid | MI | |
| LM039076 | Other | CHAMPUS-CHAMPUS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 039076 | MI | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1255409702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2520 S TELEGRAPH ROAD",
"address_2": "HENRY FORD HEALTH SYSTEM",
"city": "BLOOMFIELD HILLS",
"state": "MI",
"postal_code": "48330",
"telephone_number": "248-451-6001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HENRY FORD HEALTH SYSTEM",
"address_2": "6777 WEST MAPLE ROAD",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "48323",
"telephone_number": "248-661-6450",
"fax_number": "248-661-6649"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "LAWRENCE",
"middle_name": "C.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-01",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "039076",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS-BLUE CROSS",
"identifier": "700H262220",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMERCIAL-COMMERCIAL NUMBER",
"identifier": "LM039076",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "137335810",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS-CHAMPUS",
"identifier": "LM039076",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.