Idol R Mitchell Dpm Pc

LBN: Idol R Mitchell Dpm Pc
Idol R Mitchell Dpm Pc is an health care organization with primary practice located at 437 East Grant Street , Macomb IL 61455-3352. The organization recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as the primary health care specialty. Idol R Mitchell Dpm Pc can be contacted via phone (309) 837-3964, or through Mitchell, Idol R. via phone (309) 836-7900.

Contact Information

Primary practice address
437 East Grant Street Macomb IL 61455-3352
Phone: (309) 837-3964
Fax: (309) 837-3966
Website:
Map and Directions
Authorized official contact:
Name: Mitchell, Idol R.
Phone: (309) 836-7900

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X 016004683 Illinois

Profile Details

NPI number 1003987173
LBN Legal business name Idol R Mitchell Dpm Pc
DBA Doing business as
Authorized official Mitchell, Idol R.
Entity Organization
Organization subpart 1 No
Enumeration date Nov 12th, 2006
Last updated Jun 30th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003987173 NPPES
Illinois MEDICAID 016004683
Illinois Other 480034728
Illinois Other 4452210001
Illinois Other 214428

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