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NPI Code Detail

MEDICARE: DR. ALBERT GEORGE MITSOS M.D.

MEDICARE: DR. ALBERT GEORGE MITSOS M.D.
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
1173000000XLegal Medicine036.057690IL

General Provider Information

NPI Number : 1487923330
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALBERT GEORGE MITSOS M.D.
Provider Business Mailing Address
First Line : 5675 PORT CLINTON RD
Second Line :
City : LONG GROVE
State : IL
Zip : 60047-5059
Country : US
Telephone Number : 847-634-2206
Fax Number : 847-821-1108
Provider Business Practice Location Address
First Line : 5675 PORT CLINTON RD
Second Line :
City : LONG GROVE
State : IL
Zip : 60047-5059
Country : US
Telephone Number : 847-634-2206
Fax Number : 847-821-1108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/22/2011
Last Update Date : 12/22/2011

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