Individual
CHARLES L MITCHELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1424 E 53RD ST, SUITE 301, CHICAGO, IL 60615-4500
(773) 324-3338
(773) 324-1866
Mailing address
1424 E 53RD ST, SUITE 301, CHICAGO, IL 60615-4500
(773) 324-3338
(773) 324-1866
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016-004908
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016004908
—
IL
01
—
1634266
BLUE CROSS BLUE SHIELD
IL
01
—
609279300
DEPT OF LABOR
IL
01
—
P00243141
RAILROAD MEDICARE
IL
Enumeration date
07/06/2006
Last updated
04/30/2015
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