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General NPI Number Information
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NPI Number | 1871706523
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Entity Type | Individual
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Provider Name | KOCHUTHRESIA MATHAI NEDUMGOTTIL M.D
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1901 W. HARRISON ST.
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City | CHICAGO
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State | IL
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Zip | 60612
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Country | US
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Telephone | 312-864-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 216 79TH STREET
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City | WILLOWBROOK
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State | IL
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Zip | 60527-2407
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Country | US
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Telephone | 630-920-1569
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Fax | 630-310-8583
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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 | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number |
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License Number State | IL
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