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General NPI Number Information
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NPI Number | 1205922770
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Entity Type | Individual
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Provider Name | PETHAM MUTHUSWAMY M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7531 SOUTH STONY ISLAND SUITE 169
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City | CHICAGO
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State | IL
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Zip | 60649
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Country | US
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Telephone | 773-947-7715
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Fax | 773-643-0175
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Provider Business Mailing Address
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Address Line | 7531 SOUTH STONY ISLAND SUITE 169
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City | CHICAGO
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State | IL
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Zip | 60649
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Country | US
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Telephone | 773-947-7715
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Fax | 773-643-0175
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036047024
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 03604724
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 03604724
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License Number State | IL
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