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General NPI Number Information
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NPI Number | 1609843655
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Entity Type | Individual
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Provider Name | KALARICKAL J OOMMEN MD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 3506 21ST ST SUITE 400
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City | LUBBOCK
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State | TX
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Zip | 79410
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Country | US
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Telephone | 806-725-4115
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Fax | 806-723-7007
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Provider Business Mailing Address
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Address Line | 2215 NASHVILLE AVE
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City | LUBBOCK
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State | TX
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Zip | 79410-1105
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Country | US
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Telephone | 806-725-5844
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Fax | 806-723-6532
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | N4871
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 11431
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | N4871
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License Number State | TX
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