Mitchell Jackson, MD

NPI 1902958929 · on the registry since 2007

Practice

Address: 300 N Milwaukee Ave
Suite L Jacksoneye Sc
Lake Villa, IL 60046
Phone: (847) 356-0700
Fax: (847) 356-0757
Organisation at this address: Jacksoneye Sc
De Los Reyes Dental Ltd.
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 5

Registry record

Primary taxonomy: 207W00000X
207W00000X
Licence states on file: IL
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2014-01-09

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Illinois