Healthcare Provider Details

I. General information

NPI: 1184663247
Provider Name (Legal Business Name): REENI M KARAVATTUVEETIL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REENI ABRAHAM

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

3249 S. OAK PARK AVE.
BERWYN IL
60402
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2696
  • Fax: 708-783-3164
Mailing address:
  • Phone: 708-783-2696
  • Fax: 708-783-3164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036-093026
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.091684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: