Healthcare Provider Details

I. General information

NPI: 1376615518
Provider Name (Legal Business Name): CHICAGO SURGICARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1424 E 53RD ST
CHICAGO IL
60615-4500
US

IV. Provider business mailing address

1424 E 53RD ST
CHICAGO IL
60615-4500
US

V. Phone/Fax

Practice location:
  • Phone: 773-324-3338
  • Fax: 773-324-1866
Mailing address:
  • Phone: 773-324-3338
  • Fax: 773-324-1866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES MITCHELL
Title or Position: PREIDENT
Credential: DPM
Phone: 773-324-3338