Provider Demographics
NPI:1588045017
Name:MITCHELL, CALEB J (DO)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:J
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1201 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1634
Mailing Address - Country:US
Mailing Address - Phone:618-273-3361
Mailing Address - Fax:618-273-2504
Practice Address - Street 1:1340 IL HIGHWAY 1 STE E
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821
Practice Address - Country:US
Practice Address - Phone:618-380-9321
Practice Address - Fax:618-273-2504
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036146015207Q00000X
IN11018326A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine