Organization
PRODYOT K. MITRA, M.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PRODYOT K MITRA M.D. (OWNER)
(815) 344-0621
Entity
Organization
Contact information
Practice address
633 RIDGEVIEW DR, MCHENRY, IL 60050-7012
(815) 344-0621
(815) 344-0664
Mailing address
633 RIDGEVIEW DR, MCHENRY, IL 60050-7012
(815) 344-0621
(815) 344-0664
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036062584
IL
208600000X
Surgery Physician
Primary
036052608
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052608
—
IL
05
—
036062584
—
IL
Enumeration date
03/18/2008
Last updated
10/23/2013
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