Provider Demographics
NPI:1659409886
Name:CHETNA MITAL MD LLC
Entity Type:Organization
Organization Name:CHETNA MITAL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHETNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-867-2622
Mailing Address - Street 1:1010 CEREAL AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2776
Mailing Address - Country:US
Mailing Address - Phone:513-867-2622
Mailing Address - Fax:513-844-2093
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013
Practice Address - Country:US
Practice Address - Phone:513-867-2622
Practice Address - Fax:513-844-2093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0660520Medicaid
OHCH9360031Medicare ID - Type Unspecified