Individual
JERRY E MITCHELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3315 N SEMINARY ST, GALESBURG, IL 61401-1251
(309) 344-1000
(309) 344-1054
Mailing address
3315 N SEMINARY ST, GALESBURG, IL 61401-1251
(309) 344-1000
(309) 344-1054
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10621858
CAQH
—
01
—
364271985-38
JOHN DEERE
—
01
—
4022647
AETNA
—
01
—
4815127
BC/BS
—
Enumeration date
09/26/2006
Last updated
07/08/2007
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