Provider Demographics
NPI:1083829378
Name:MITCHELL, MYROSIA TOMIAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MYROSIA
Middle Name:TOMIAK
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:195 N HARBOR DR APT 4802
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7540
Mailing Address - Country:US
Mailing Address - Phone:773-702-3911
Mailing Address - Fax:773-702-1161
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:ADVOCATE CHRIST MEDICAL CENTER, DEPT. OF RADIOLOGY
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-915-5671
Practice Address - Fax:708-915-4022
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360772852085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077285Medicaid
ILL31664Medicare ID - Type Unspecified