Provider Demographics
NPI:1174505325
Name:MITCHELL, MICHELE M (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 W WACKER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-1606
Mailing Address - Country:US
Mailing Address - Phone:571-721-8689
Mailing Address - Fax:
Practice Address - Street 1:1923 W GLEN PARK AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-3703
Practice Address - Country:US
Practice Address - Phone:219-922-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.159710207Q00000X
FLME88708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2140598Medicaid
GA20280I5275Medicare UPIN