MEDICARE: JOBBY MAMPILLY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036.120190	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036120190	IL
3	207RP1001X	Pulmonary Disease Physician	036120190	IL

General Provider Information

NPI Number	:	1639340029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOBBY MAMPILLY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 713260
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-1260
Country	:	US
Telephone Number	:	630-469-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 SPALDING DR STE 102
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-6551
Country	:	US
Telephone Number	:	630-871-6699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	08/10/2023

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