Organization
NORTHWEST MEDICAL ASSOCIATES, SC
Active
Other names
CHARLOTTE MITCHELL,.M.D. S.C.
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLOTTE MITCHELL M.D. (SOLE OWNER)
(708) 754-3225
Entity
Organization
Contact information
Practice address
30 E 15TH ST, SUITE 310, CHICAGO HEIGHTS, IL 60411-3459
(708) 754-3225
Mailing address
30 E 15TH ST, SUITE 310, CHICAGO HEIGHTS, IL 60411-3459
(708) 754-3225
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
036079491
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036079491
—
IL
01
—
31603733
BLUE CROSS
IL
Enumeration date
11/10/2007
Last updated
02/22/2014
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