NPIMap

Organization Active NPI

Mikelson & Mikelson P.C.

  • General Practice Dentistry
  • Chicago, IL
National Provider Identifier
1124215272
Registry record updated Oct 2, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MIKELSON & MIKELSON P.C.
Practice address
3838 W 111TH St Ste 105
Chicago, IL 60655-4042
Phone
(773) 233-6300
NPI assigned
Oct 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2007

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

Authorized official

Name
Dr. Robert C. Mikelson Jr., D.D.S.NPI 1104114214
Title
President
Phone
(773) 233-6300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X IL Primary

Addresses

Primary practice location

3838 W 111TH St Ste 105
Chicago, IL 60655-4042

Mailing address

3838 W 111TH St Ste 105
Chicago, IL 60655-4042
Phone (773) 233-6300

National Provider Directory

National Provider Directory

Locations

3838 W 111th St
Ste 105
Chicago, IL 60655
Phone (773) 233-6300

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1124215272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3838 W 111TH ST STE 105",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606554042",
            "telephone_number": "773-233-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 W 111TH ST STE 105",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606554042",
            "telephone_number": "773-233-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKELSON & MIKELSON P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "MIKELSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-233-6300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 2, 2007; 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.