Healthcare Provider Details

I. General information

NPI: 1821558065
Provider Name (Legal Business Name): BLAIR ELIZABETH MITCHELL-HANDLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLAIR ELIZABETH MITCHELL

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3981
US

IV. Provider business mailing address

101 W UNIVERSITY AVE
CHAMPAIGN IL
61820-3981
US

V. Phone/Fax

Practice location:
  • Phone: 217-366-1255
  • Fax:
Mailing address:
  • Phone: 217-366-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036158884
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: