MEDICARE: CHARLES L MITCHELL DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	016-004908	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00243141	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1634266	OTHER	IL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	609279300	OTHER	IL	DEPT OF LABOR

General Provider Information

NPI Number	:	1356372197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES L MITCHELL DPM

Provider Business Mailing Address
First Line	:	1424 E 53RD ST
Second Line	:	SUITE 301
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	:	SUITE 301
City	:	CHICAGO
State	:	IL
Zip	:	60615-4500
Country	:	US
Telephone Number	:	773-324-3338
Fax Number	:	773-324-1866

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/30/2015

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Directions to “ CHARLES L MITCHELL DPM” Practice Location

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