Active NPI
Mitchele Hogan, MD
- Adult Medicine Physician
- Chicago, IL
National Provider Identifier
1063507127
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Medicine Physician
- License
- 336.027529 036.06299
- Practice address
- 822 S Miller St
Chicago, IL 60607-4207 - Phone
- (312) 733-9010
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 336.027529 036.06299 | IL | Primary |
Addresses
Primary practice location
822 S Miller St
Chicago, IL 60607-4207
Mailing address
826 S Miller St
Chicago, IL 60607-4207
Phone (312) 733-9010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036062994 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 336.027529 036.06299 | IL | MD | Adult Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496275200000",
"number": "1063507127",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "826 S MILLER ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606074207",
"telephone_number": "312-733-9010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "822 S MILLER ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606074207",
"telephone_number": "312-733-9010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOGAN",
"first_name": "MITCHELE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2017-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "207QA0505X",
"taxonomy_group": "",
"desc": "Family Medicine, Adult Medicine",
"state": "IL",
"license": "336.027529 036.06299",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036062994",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.