| Prodyot K. Mitra, M.d. | |
|
633 Ridgeview Dr Mchenry IL 60050-7012 | |
| (815) 344-0621 | |
| (815) 344-0664 |
| Full Name | Prodyot K. Mitra, M.d. |
|---|---|
| Speciality | Surgery |
| Location | 633 Ridgeview Dr, Mchenry, Illinois |
| Authorized Official Name and Position | Prodyot K Mitra (OWNER) |
| Authorized Official Contact | 8153440621 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Prodyot K. Mitra, M.d. 633 Ridgeview Dr Mchenry IL 60050-7012 Ph: (815) 344-0621 | Prodyot K. Mitra, M.d. 633 Ridgeview Dr Mchenry IL 60050-7012 Ph: (815) 344-0621 |
| NPI Number | 1477724425 |
|---|---|
| Provider Enumeration Date | 03/18/2008 |
| Last Update Date | 10/23/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477724425 | NPI | - | NPPES |
| 036052608 | Medicaid | IL | |
| 036062584 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036062584 (Illinois) | Secondary |
| 208600000X | Surgery | 036052608 (Illinois) | Primary |
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