MEDICARE: CHICAGO SURGICARE, PC

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	261QP1100X	Podiatric Clinic/Center

General Provider Information

NPI Number	:	1376615518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO SURGICARE, PC

Provider Business Mailing Address
First Line	:	1424 E 53RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4500
Country	:	US
Telephone Number	:	773-324-3338
Fax Number	:	773-324-1866

Provider Business Practice Location Address
First Line	:	1424 E 53RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4500
Country	:	US
Telephone Number	:	773-324-3338
Fax Number	:	773-324-1866

Authorized Official
Title or Position	:	PREIDENT
Name	:	DR. CHARLES MITCHELL
Credential	:	DPM
Telephone Number	:	773-324-3338

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	04/30/2015

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