Provider Demographics
NPI:1467491092
Name:MITCHELL, ROBERT J (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 WEST ST
Mailing Address - Street 2:STE 211
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2763
Mailing Address - Country:US
Mailing Address - Phone:815-223-2143
Mailing Address - Fax:
Practice Address - Street 1:920 WEST ST
Practice Address - Street 2:STE 211
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2763
Practice Address - Country:US
Practice Address - Phone:815-223-2143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096898207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL200039264OtherRAILROAD MEDICARE
IL4119029001OtherCIGNA
IL005723OtherHEALTH ALLIANCE
IL036096898Medicaid
IL7872232OtherAETNA
IL819300025Medicare PIN
IL4119029001OtherCIGNA
IL005723OtherHEALTH ALLIANCE