Individual
DONITA MITCHELL-GAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
619 E BOUGHTON RD, STE 143-II, BOLINGBROOK, IL 60440-2486
(708) 516-0128
(815) 782-6900
Mailing address
1369 ROSEMARY DR, BOLINGBROOK, IL 60490-4940
(708) 516-0128
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
012.008279
IL
Other
Enumeration date
01/26/2015
Last updated
04/08/2015
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