Individual
DONALD A MITZELFELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2351 BROADWAY ST, PEKIN, IL 61554-3972
(309) 353-4159
(309) 353-4531
Mailing address
2351 BROADWAY ST, PEKIN, IL 61554-3972
(309) 353-4159
(309) 353-4531
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036088541
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088541
—
IL
01
—
09015685
BLUE CROSS BLUE SHIELD
IL
01
—
P00282243
RAIL ROAD MEDICARE PIN
IL
Enumeration date
05/17/2006
Last updated
12/31/2019
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