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Contact Information

MITCHELL DAUGHERTY
1815 E IRELAND RD
SOUTH BEND, IN46614-2845
 Phone: 574-647-1700
 Fax: 574-647-7572
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine - Sports Medicine

207QS0010X 08 Physician/Family Practice
 

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MITCHELL DAUGHERTY · (Male)

NPI Number 1417481540
Status Active
Credentials
Entity Individual
Enumeration date 04/14/2017
Last updated 06/20/2025 - About 12 months ago
Sole proprietor 1 No
Identifiers
  • IN License # 01082368A
  • IN Medicaid 300003172
Hospital affiliation(s)
  • COMMUNITY HOSPITAL OF BREMEN INC - (Critical Access)
    1020 HIGH RD
    BREMEN, IN 46506
  • MEMORIAL HOSPITAL OF SOUTH BEND - (Acute Care)
    615 N MICHIGAN ST
    SOUTH BEND, IN 46601
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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