Active NPI
Donald E Mitzelfelt, MD
- Family Medicine Physician
- Peoria, IL
National Provider Identifier
1790878809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 036039927
- Practice address
- 3915 Barring Trace
Peoria, IL 61615 - Phone
- (309) 689-3030
- Fax
- (309) 689-6280
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036039927 | IL | Primary |
Addresses
Primary practice location
3915 Barring Trace
Peoria, IL 61615
Mailing address
1120 E War Memorial Dr
Peoria Height, IL 61616
Phone (309) 685-0100
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)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1790878809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1120 E WAR MEMORIAL DR",
"city": "PEORIA HEIGHT",
"state": "IL",
"postal_code": "61616",
"telephone_number": "309-685-0100",
"fax_number": "309-685-0172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3915 BARRING TRACE",
"city": "PEORIA",
"state": "IL",
"postal_code": "61615",
"telephone_number": "309-689-3030",
"fax_number": "309-689-6280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITZELFELT",
"first_name": "DONALD",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "036039927",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.