Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036-118366 | IL |
Y | 2080P0203X | Pediatric Critical Care Doctor | 036118366 | IL |
NPI | 1083881650 |
---|---|
Provider Name | Dr. Diana Lily Mitchell |
First Address | Park Ridge, IL 60068-1110 |
Second Address | Park Ridge, IL 60068-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 12/03/2020 |