Donita Mitchell-Gage, CERTIFIED HAIR LOSS

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

012.008279 Issued in IL

Practice address

619 E Boughton Rd
Ste 143-II
Bolingbrook, IL 60440-2486

Phone

(708) 516-0128

Fax

(815) 782-6900

NPI assigned

Jan 26, 2015

Last updated

Apr 8, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1422230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428451200000",
    "number": "1477943736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1369 ROSEMARY DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604904940",
            "telephone_number": "708-516-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 E BOUGHTON RD",
            "address_2": "STE 143-II",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604402486",
            "telephone_number": "708-516-0128",
            "fax_number": "815-782-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL-GAGE",
        "first_name": "DONITA",
        "credential": "CERTIFIED HAIR LOSS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-26",
        "last_updated": "2015-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "IL",
            "license": "012.008279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthetics Case Management in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Prosthetics Case Management in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2015; 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.