Jackson, Mitchell Alin
Jackson, Mitchell Alin is an individual health care provider with primary practice located at 300 N Milwaukee Ave Suite L Jacksoneye Sc, Lake Villa IL 60046. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Jackson, Mitchell Alin can be contacted via phone (847) 356-0700.Contact Information
Primary practice address
300 N Milwaukee Ave Suite L Jacksoneye Sc
Lake Villa IL 60046
Phone: (847) 356-0700
Fax: (847) 356-0757
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 036083377 | Illinois |
Profile Details
NPI number | 1902958929 |
---|---|
LBN Legal business name | Jackson, Mitchell Alin |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jan 18th, 2007 |
Last updated | Jan 9th, 2014 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1902958929 | NPPES |
Illinois | Other | 0004932263 | BCBS # |
Illinois | Other | 208201 | BCBS # |
Illinois | MEDICAID | 036083377 | BCBS # |
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