Jackson, Mitchell Alin

Jackson, Mitchell Alin is an individual health care provider with primary practice located at 300 N Milwaukee Ave Suite L Jacksoneye Sc, Lake Villa IL 60046. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Jackson, Mitchell Alin can be contacted via phone (847) 356-0700.

Contact Information

Primary practice address
300 N Milwaukee Ave Suite L Jacksoneye Sc Lake Villa IL 60046
Phone: (847) 356-0700
Fax: (847) 356-0757
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Ophthalmology 207W00000X 036083377 Illinois

Profile Details

NPI number 1902958929
LBN Legal business name Jackson, Mitchell Alin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 18th, 2007
Last updated Jan 9th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902958929 NPPES
Illinois Other 0004932263 BCBS #
Illinois Other 208201 BCBS #
Illinois MEDICAID 036083377 BCBS #

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