Daugherty, Mitchell

Daugherty, Mitchell is an individual health care provider with primary practice located at 1815 E Ireland Rd , South Bend IN 46614-2845. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Daugherty, Mitchell can be contacted via phone (574) 647-1700.

Contact Information

Primary practice address
1815 E Ireland Rd South Bend IN 46614-2845
Phone: (574) 647-1700
Fax: (574) 647-7572
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01082368A Indiana
Allopathic & Osteopathic Physicians / Sports Medicine 207QS0010X 01082368A Indiana

Profile Details

NPI number 1417481540
LBN Legal business name Daugherty, Mitchell
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2017
Last updated Jun 20th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417481540 NPPES
Indiana MEDICAID 300003172

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