Maureen Sue Mietelski, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

036067284 Issued in IL

Practice address

222 Colorado Ave.
Frankfort, IL 60423-1334

Phone

(815) 469-6646

Fax

(815) 469-6647

NPI assigned

Jul 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639008000000",
    "number": "1477567337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 COLORADO AVE.",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604231334",
            "telephone_number": "815-469-6646",
            "fax_number": "815-469-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 COLORADO AVE.",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604231334",
            "telephone_number": "815-469-6646",
            "fax_number": "815-469-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIETELSKI",
        "first_name": "MAUREEN",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2021-12-09",
        "certification_date": "2021-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "IL",
            "license": "036067284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Frankfort, IL
• Providers in Frankfort, IL by specialty
• Obstetrics & Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2021; 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.