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Individual
IDOL RAY MITCHELL
Active
Individual
IDOL RAY MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016-004683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004683
—
IL
01
—
214428
MEDICARE ID
IL
01
—
4452210001
DMERC
—
01
—
480034728
RAILROAD MEDICARE PROV #
—
Enumeration date
09/06/2005
Last updated
05/15/2008
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