Individual
DEEPAK MITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
633 RIDGEVIEW DR, MCHENRY, IL 60050-7012
(815) 344-2760
(815) 344-0664
Mailing address
633 RIDGEVIEW DR, MCHENRY, IL 60050-7012
(815) 344-2760
(815) 344-0664
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-122249
IL
207R00000X
Internal Medicine Physician
49813
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
552920000
—
MN
01
—
MITRADEE
MERCYCARE INSURANCE
WI
01
—
P00684628CG6042
RR MEDICARE
IL
Enumeration date
02/09/2007
Last updated
04/19/2022
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