Individual
DR. KOHL MITCHELL MAYBERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1335 N MILL ST STE 100, NAPERVILLE, IL 60563-2047
(630) 305-5027
Mailing address
302 RANDALL RD STE 308, GENEVA, IL 60134-4205
(630) 933-4056
(630) 208-3007
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036.156105
IL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036156105
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007622900
—
FL
Enumeration date
05/24/2011
Last updated
12/05/2023
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