Organization
IDOL R MITCHELL DPM PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IDOL R. MITCHELL (PRESIDENT)
(309) 836-7900
Entity
Organization
Contact information
Practice address
437 EAST GRANT STREET, MACOMB, IL 61455-3352
(309) 837-3964
(309) 837-3966
Mailing address
437 EAST GRANT STREET, MACOMB, IL 61455-3352
(309) 837-3964
(309) 837-3966
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016004683
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004683
—
IL
01
—
214428
MEDICARE ID
IL
01
—
4452210001
DMERC
—
01
—
480034728
RAILROAD MEDICARE
—
Enumeration date
11/12/2006
Last updated
06/30/2008
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