MEDICARE: CHETNA MITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35-053073	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285637694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHETNA MITAL

Provider Business Mailing Address
First Line	:	1010 CEREAL AVE STE 103
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-2776
Country	:	US
Telephone Number	:	513-867-2622
Fax Number	:	513-867-2093

Provider Business Practice Location Address
First Line	:	1010 CEREAL AVE STE 307
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-2777
Country	:	US
Telephone Number	:	513-454-1111
Fax Number	:	513-737-1592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/08/2026

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