Provider Demographics
NPI:1730189598
Name:GOLDFLIES, MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:GOLDFLIES
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 1:6445 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-2901
Mailing Address - Country:US
Mailing Address - Phone:773-792-3311
Mailing Address - Fax:773-775-6212
Practice Address - Street 1:6445 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-2901
Practice Address - Country:US
Practice Address - Phone:773-792-3311
Practice Address - Fax:773-775-6212
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052967207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052967Medicaid
ILC44971Medicare UPIN
IL652380Medicare ID - Type Unspecified