Organization
MATHEW OOMMEN MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATHEW OOMMEN MD SC (OWNER)
(773) 585-0001
Entity
Organization
Contact information
Practice address
6449 S PULASKI RD, STE#110, CHICAGO, IL 60629-5148
(773) 585-0001
(630) 920-0395
Mailing address
6449 S PULASKI RD, STE#110, CHICAGO, IL 60629-5148
(773) 585-0001
(630) 920-0395
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21607634
BCBS
IL
Enumeration date
04/24/2007
Last updated
08/22/2020
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