Provider Demographics
NPI:1922021674
Name:DREXLER, MITCHELL (DPM MPH)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:DREXLER
Suffix:
Gender:M
Credentials:DPM MPH
Other - Prefix:DR
Other - First Name:MITCHELL
Other - Middle Name:
Other - Last Name:DREXLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM MPH
Mailing Address - Street 1:3553 BUENA RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1003
Mailing Address - Country:US
Mailing Address - Phone:847-858-7035
Mailing Address - Fax:708-423-2991
Practice Address - Street 1:4817 W 83RD ST
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459-2790
Practice Address - Country:US
Practice Address - Phone:708-425-3135
Practice Address - Fax:708-425-6884
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002638213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016002638OtherLICENSE
IL316000425OtherSUBSTANCE CONTROLLED
IL203587OtherMEDICARE
IL016002638Medicaid
IL60020753OtherBCBS
ILAD4444270OtherDEA
IL316000425OtherSUBSTANCE CONTROLLED
T36900Medicare UPIN
IL60020753OtherBCBS
ILK50364Medicare PIN
ILF400137517Medicare PIN