Healthcare Provider Details

I. General information

NPI: 1720583396
Provider Name (Legal Business Name): ALEXANDRA MITCHELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 N BROADWAY ST
CHICAGO IL
60640-3007
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-8890
  • Fax: 773-293-8899
Mailing address:
  • Phone: 847-982-6715
  • Fax: 847-982-3394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036156515
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: