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General NPI Number Information
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NPI Number | 1134215569
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Entity Type | Individual
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Provider Name | KUMAR DAMODARAN MOOLAYIL M.D
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Gender | Male
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 200 SAINT MICHAEL CT
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City | OAK BROOK
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State | IL
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Zip | 60523-2556
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Country | US
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Telephone | 708-214-9349
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Fax | 630-986-8390
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Provider Business Mailing Address
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Address Line | 200 SAINT MICHAEL CT
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City | OAK BROOK
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State | IL
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Zip | 60523-2556
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Country | US
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Telephone | 708-214-9349
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Fax | 630-986-8390
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036058128
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License Number State | IL
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