Provider Demographics
NPI:1356347736
Name:MISCHEL, STEVEN (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MISCHEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2708 N RACINE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1206
Mailing Address - Country:US
Mailing Address - Phone:773-525-3508
Mailing Address - Fax:
Practice Address - Street 1:10120 CALUMET AVE STE 103
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4076
Practice Address - Country:US
Practice Address - Phone:219-836-2936
Practice Address - Fax:219-836-2949
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000848A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100189270Medicaid
IN703060FMedicare PIN
IN164220BMedicare PIN
E03796Medicare UPIN