Individual
DR. CORNELIUS AVERY MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
31 W 155TH ST, HARVEY, IL 60426-3556
(708) 596-5177
(708) 339-3583
Mailing address
9119 S EXCHANGE AVE, CHICAGO, IL 60617-4225
(773) 768-5000
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
036115063
IL
207Q00000X
Family Medicine Physician
Primary
036.115063
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036115063
—
IL
Enumeration date
06/26/2006
Last updated
08/16/2018
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