Healthcare Provider Details

I. General information

NPI: 1699679555
Provider Name (Legal Business Name): JAMES VETTIKKATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 N CORONA DR
ROLLING MEADOWS IL
60067-7369
US

IV. Provider business mailing address

5802 N CORONA DR
ROLLING MEADOWS IL
60067-7369
US

V. Phone/Fax

Practice location:
  • Phone: 847-220-2227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041339529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: