# NORTHWEST MEDICAL ASSOCIATES, SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CHARLOTTE MITCHELL,.M.D. S.C.
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700066453
- **Authorized official:** CHARLOTTE MITCHELL M.D. (SOLE OWNER)
- **Authorized official phone:** (708) 754-3225

## Contact information

- **Practice address:** 30 E 15TH ST, SUITE 310, CHICAGO HEIGHTS, IL 60411-3459
- **Practice address phone:** (708) 754-3225
- **Mailing address:** 30 E 15TH ST, SUITE 310, CHICAGO HEIGHTS, IL 60411-3459
- **Mailing address phone:** (708) 754-3225

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 036079491 | IL | Yes |

## Other

- **Enumeration date:** 11/10/2007
- **Last updated:** 02/22/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036079491 | — | IL |
| 01 | — | 31603733 | BLUE CROSS | IL |