Provider Demographics
NPI:1356468656
Name:MITCHELL, SUSAN T (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:T
Last Name:MITCHELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5N958 SURREY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-2016
Mailing Address - Country:US
Mailing Address - Phone:312-622-2052
Mailing Address - Fax:
Practice Address - Street 1:1319 BUTTERFIELD RD STE 506
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5601
Practice Address - Country:US
Practice Address - Phone:630-320-6703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4827-320207V00000X
IN01086121A207V00000X
IL036117849207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036117849Medicaid
WI1356468656Medicaid
IDP00447359OtherRAILROAD MEDICARE