Individual
KRISTOFER J. MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N 1ST ST, SPRINGFIELD, IL 62702-3719
(217) 528-7541
Mailing address
1025 S 6TH ST, SPRINGFIELD, IL 62703-2403
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036120394
IL
2086S0102X
Surgical Critical Care Physician
036120394
IL
2086S0127X
Trauma Surgery Physician
036120394
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036120394
—
IL
01
—
R01662
MEDICARE PTAN
IL
Enumeration date
05/09/2007
Last updated
01/31/2022
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