Provider Demographics
NPI:1720233240
Name:MITCHELL NEEDLEMAN, D.P.M.
Entity Type:Organization
Organization Name:MITCHELL NEEDLEMAN, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:NEEDLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:618-234-8333
Mailing Address - Street 1:16 PARK PL STE A
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2928
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16 PARK PL STE A
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2928
Practice Address - Country:US
Practice Address - Phone:618-234-8333
Practice Address - Fax:618-234-8349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003942213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty