Individual
MR. PRODYOT KUMAR MITRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
633 RIDGEVIEW DRIVE, MCHENRY, IL 60050-7012
(815) 344-0621
(815) 344-0664
Mailing address
633 RIDGEVIEW DRIVE, MCHENRY, IL 60050-7012
(815) 344-0621
(815) 344-0664
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036052608
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
024000852
RAILROAD MEDICARE
IL
05
—
0360526081
—
IL
01
—
05600205
BLUE CROSS BLUE SHIELD
IL
01
—
5432896
CIGNA
IL
Enumeration date
11/27/2006
Last updated
05/08/2008
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