MEDICARE: DR. KRISTINA KELLY MITTON 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	208000000X	Pediatrics Physician	036133431	IL

General Provider Information

NPI Number	:	1922328640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA KELLY MITTON M.D.

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-1293
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	2551 COMPASS RD STE 100
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-8042
Country	:	US
Telephone Number	:	847-729-6445
Fax Number	:

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	09/02/2022

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