| Doctor Name: | DR. DIEUDONNE MITIAL |
| NPI Number: | 1750766465 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D., M.H.S.A |
| License Number: | 19073 |
| Business Practice Address: | 1393 W Split Oak Cir Round Lake Beach, IL - 600734675 |
| Business Phone Number: | 7732633424 |
| Business Fax Number: | |
| Mailing Address: | 1393 W Split Oak Cir, ROUND LAKE BEACH |
| State: | IL |
| Postal Code: | 600734675 |
| Phone Number: | 7732633424 |
| Fax Number: | |
| NPI Enumeration Date: | 07/23/2015 |
| NPI Last Update Date: | 08/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 19073 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PR |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |