Individual
DR. MITCHELL ALIN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 N MILWAUKEE AVE, SUITE L JACKSONEYE SC, LAKE VILLA, IL 60046
(847) 356-0700
(847) 356-0757
Mailing address
300 N MILWAUKEE AVE, SUITE L JACKSONEYE SC, LAKE VILLA, IL 60046
(847) 356-0700
(847) 356-0757
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036083377
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004932263
BCBS #
IL
05
—
036083377
—
IL
01
—
208201
MEDICARE ID
IL
Enumeration date
01/18/2007
Last updated
01/09/2014
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