Mitchell, Cornelius Avery

Mitchell, Cornelius Avery is an individual health care provider with primary practice located at 31 W 155Th St , Harvey IL 60426-3556. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Other Service Providers / Legal Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Mitchell, Cornelius Avery can be contacted via phone (708) 596-5177.

Contact Information

Primary practice address
31 W 155Th St Harvey IL 60426-3556
Phone: (708) 596-5177
Fax: (708) 339-3583
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036.115063 Illinois
Other Service Providers / Legal Medicine 173000000X 036115063 Illinois

Profile Details

NPI number 1225065345
LBN Legal business name Mitchell, Cornelius Avery
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 26th, 2006
Last updated Aug 16th, 2018 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225065345 NPPES
Illinois MEDICAID 036115063

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