DR. DONALD E MITZELFELT MD NPI 1790878809

Family Medicine in Peoria, IL

About DONALD MITZELFELT

Donald Mitzelfelt is a provider in Peoria, IL with more than 54 years of experience. The NPI number assigned to this provider is 1790878809. The practitioner's primary taxonomy code is Family Medicine (207Q00000X). The provider is registered as an individual and their NPI record was last updated 10 years ago. Donald Mitzelfelt is registered with Medicare and accepts claims assignment.

NPI1790878809 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. DONALD E MITZELFELT MD
Provider Location Address3915 BARRING TRACE PEORIA, IL 61615 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address1120 E WAR MEMORIAL DR PEORIA HEIGHT, IL 61616 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameLOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year1964
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date10-02-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date07-09-2007 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. DONALD E MITZELFELT MD
3915 BARRING TRACE
PEORIA, IL
ZIP 61615
Phone: (309) 689-3030
Fax: (309) 689-6280
Get Directions

Mailing Address

DR. DONALD E MITZELFELT MD
1120 E WAR MEMORIAL DR
PEORIA HEIGHT, IL
ZIP 61616
Phone: (309) 685-0100
Fax: (309) 685-0172

Primary Taxonomy

Taxonomy Code207Q00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.036039927
License StateIL
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
C51956MEDICARE UPIN (02)IL

Map Location


DR. DONALD E MITZELFELT MD address is 3915 BARRING TRACE PEORIA, IL 61615

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1316909328 ZIAD MUSAITIF DO
Individual
Family Medicine3915 BARRING TRACE
PEORIA, IL 61615
(309) 689-3030