Idol R Mitchell DPM PC

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016004683 Issued in IL

Legal business name

IDOL R MITCHELL DPM PC

Practice address

437 East Grant Street
Macomb, IL 61455-3352

Phone

(309) 837-3964

Fax

(309) 837-3966

NPI assigned

Nov 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Idol R. Mitchell

Title

President

Phone

(309) 836-7900

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214784000000",
    "number": "1003987173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 EAST GRANT STREET",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553352",
            "telephone_number": "309-837-3964",
            "fax_number": "309-837-3966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 EAST GRANT STREET",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553352",
            "telephone_number": "309-837-3964",
            "fax_number": "309-837-3966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDOL R MITCHELL DPM PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-12",
        "last_updated": "2008-06-30",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "IDOL",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-836-7900",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016004683",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016004683",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "480034728",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4452210001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "214428",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Highland Park CVS LLC
• Amy Renee Hofmeister, MSED, LCPC
• Reagan Horsch
• Angela Hoyt
• Hy-Vee Inc
• Illinois Medicaid-Substance Abuse Macomb
• Erika Dawn Ingolia, BCABA
• Isabelo Castillo, MDSC
• Daphne Isme, FNP-C
• Richard Bruce Iverson, MD

• Podiatrist in Macomb, IL
• Providers in Macomb, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.