Mitra, Deepak

Mitra, Deepak is an individual health care provider with primary practice located at 633 Ridgeview Dr , Mchenry IL 60050-7012. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Mitra, Deepak can be contacted via phone (815) 344-2760.

Contact Information

Primary practice address
633 Ridgeview Dr Mchenry IL 60050-7012
Phone: (815) 344-2760
Fax: (815) 344-0664
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 49813 Minnesota
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036-122249 Illinois

Profile Details

NPI number 1114068467
LBN Legal business name Mitra, Deepak
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2007
Last updated Apr 19th, 2022 - about 3 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 1114068467 NPPES
Minnesota MEDICAID 552920000
Minnesota Other MITRADEE
Minnesota Other P00684628CG6042

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