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1104815323

NPI Code Detail

MEDICARE: DR. WINSTON A MITCHELL MD

MEDICARE: DR. WINSTON A MITCHELL MD

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	207L00000X	Anesthesiology Physician	01077886A	IN
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	036103962	IL
3	207Q00000X	Family Medicine Physician	036103962	IL
4	207L00000X	Anesthesiology Physician	036103962	IL

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	:	1104815323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WINSTON A MITCHELL MD

Provider Business Mailing Address
First Line	:	8600 N STATE ROUTE 91
Second Line	:	STE 250
City	:	PEORIA
State	:	IL
Zip	:	61615-9506
Country	:	US
Telephone Number	:	309-692-5393
Fax Number	:	309-692-2538

Provider Business Practice Location Address
First Line	:	2320 E 93RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60617-3909
Country	:	US
Telephone Number	:	773-967-2000
Fax Number	:

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

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/11/2018

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Directions to “ DR. WINSTON A MITCHELL MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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