Provider Demographics
NPI:1669582904
Name:MIKELL, FRANK L (MD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:L
Last Name:MIKELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19420
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9420
Mailing Address - Country:US
Mailing Address - Phone:217-788-0706
Mailing Address - Fax:217-788-0848
Practice Address - Street 1:619 E MASON ST
Practice Address - Street 2:SUITE 4P57
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62701-1034
Practice Address - Country:US
Practice Address - Phone:217-788-0706
Practice Address - Fax:217-788-0848
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064044OtherRAILROAD
IL036064044Medicaid
ILL66766Medicare ID - Type Unspecified
ILK02143Medicare PIN
IL036064044Medicaid