Amit Mittal, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

66152 Issued in MN

Practice address

15655 37TH Ave N Ste 100
Plymouth, MN 55446-4003

Phone

(630) 632-2648

Fax

(612) 230-8769

NPI assigned

May 23, 2018

Last updated

Jan 22, 2024By the provider in NPPES

Sex

Male

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

Enrolled in MN, WI, IL3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Dermatology

Education

Yale University School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mittal Dermatology, PAGroup PAC ID 5193194728, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amittalmd@mittaldermatology.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mittal Dermatology PA

  • Dermatology Physician
  • Plymouth, MN
  • NPI 1043947286

  IL, WI

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1679064851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15655 37TH AVE N STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464003",
            "telephone_number": "630-632-2648",
            "fax_number": "612-230-8769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15655 37TH AVE N STE 100",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554464003",
            "telephone_number": "630-632-2648",
            "fax_number": "612-230-8769"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 Warren St Ste 9",
            "address_purpose": "LOCATION",
            "city": "Mankato",
            "state": "MN",
            "postal_code": "560017113",
            "country_code": "US",
            "telephone_number": "630-632-2648",
            "fax_number": "612-230-8769",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5109 36th Ave N",
            "address_purpose": "LOCATION",
            "city": "Crystal",
            "state": "MN",
            "postal_code": "554222007",
            "country_code": "US",
            "telephone_number": "630-632-2648",
            "fax_number": "612-230-8769",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9825 Hospital Dr Ste 300",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694768",
            "country_code": "US",
            "telephone_number": "630-632-2648",
            "fax_number": "612-230-8769",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "50 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Osseo",
            "state": "MN",
            "postal_code": "553691241",
            "country_code": "US",
            "telephone_number": "630-632-2648",
            "fax_number": "612-230-8769",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITTAL",
        "first_name": "AMIT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-23",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MN",
            "license": "66152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Missions Inc. Programs (Mission Detox Center)
• Erin Mitchell
• Ian Mitchell
• Mancel Talcott Mitchell III, M.D.
• Mittal Dermatology PA
• Diliana Stoimenova Mittelsteadt, MD
• Pathamas Chantaracherd Mittman, DDS, MS
• Freeman Maral Mjolsness, RPH
• MK Labs LLC
• Gabriel Paul Mlodzik, CNP

• Dermatology Physician in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Dermatology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.