Marilyn L. Mitchell

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

036-063042 Issued in IL

Practice address

2075 Foxfield Rd
Suite 102
St Charles, IL 60174-1402

Phone

(847) 304-5526

NPI assigned

Oct 19, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Aug 15, 2017 through Aug 15, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Healing Space, LLC

  • Gynecology Physician
  • St Charles, IL
  • NPI 1316495534
  NPD (past) Authorized official

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1851380067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 FOXFIELD RD",
            "address_2": "SUITE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741402",
            "telephone_number": "847-304-5526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 FOXFIELD RD",
            "address_2": "SUITE 102",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741402",
            "telephone_number": "847-304-5526"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "MARILYN",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-10-19",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IL",
            "license": "036-063042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "748450",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katie Jean Miner
• Kathryn Ann Minnich-Meyer, PTA
• Bridget Mitchell, MS, RDN, LDN
• Colette Mitchell
• Karyn Mitchell, N.D., PH.D, LMT
• Paige Mitchell
• Miva Psychotherapy
• MJ Counseling LTD
• Laura Moehrlin
• Meagen Lynn Moeller

• Gynecology Physician in St Charles, IL
• Providers in St Charles, IL by specialty
• Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.