Active NPI
Albert George Mitsos, M.D.
- Legal Medicine
- Long Grove, IL
National Provider Identifier
1487923330
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Legal Medicine
- License
- 036.057690
- Practice address
- 5675 Port Clinton Rd
Long Grove, IL 60047-5059 - Phone
- (847) 634-2206
- Fax
- (847) 821-1108
- NPI assigned
- Dec 22, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Legal Medicine | 173000000X | 036.057690 | IL | Primary |
Addresses
Primary practice location
5675 Port Clinton Rd
Long Grove, IL 60047-5059
Mailing address
5675 Port Clinton Rd
Long Grove, IL 60047-5059
Phone (847) 634-2206
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036.057690 | IL | MD | Legal Medicine |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1324512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324512000000",
"number": "1487923330",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5675 PORT CLINTON RD",
"city": "LONG GROVE",
"state": "IL",
"postal_code": "600475059",
"telephone_number": "847-634-2206",
"fax_number": "847-821-1108"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5675 PORT CLINTON RD",
"city": "LONG GROVE",
"state": "IL",
"postal_code": "600475059",
"telephone_number": "847-634-2206",
"fax_number": "847-821-1108"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITSOS",
"first_name": "ALBERT",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-22",
"last_updated": "2011-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "173000000X",
"taxonomy_group": "",
"desc": "Legal Medicine",
"state": "IL",
"license": "036.057690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.