Individual
MICHAEL G NELLAMATTATHIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2650 RIDGE AVE., DEPT. OF RADIOLOGY, EVANSTON, IL 60201
(847) 570-2477
(847) 570-2942
Mailing address
2650 RIDGE AVE, EVANSTON, IL 60201-1700
(847) 570-2477
(847) 570-2942
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
036155190
IL
2085R0202X
Diagnostic Radiology Physician
Primary
036155190
IL
2085R0202X
Diagnostic Radiology Physician
OS23944
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131707900
—
FL
Enumeration date
03/26/2016
Last updated
06/25/2026
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