MEDICARE: CHARLOTTE MITCHELL 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
1	207R00000X	Internal Medicine Physician		IL

General Provider Information

NPI Number	:	1508831918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE MITCHELL M.D.

Provider Business Mailing Address
First Line	:	30 E 15TH ST
Second Line	:	SUITE 310
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3459
Country	:	US
Telephone Number	:	708-754-3225
Fax Number	:	708-754-3288

Provider Business Practice Location Address
First Line	:	30 E 15TH ST
Second Line	:	SUITE 310
City	:	CHICAGO HEIGHTS
State	:	IL
Zip	:	60411-3459
Country	:	US
Telephone Number	:	708-754-3225
Fax Number	:	708-754-3288

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	01/31/2008

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