Individual
MICHAEL NELLAMATTATHIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2650 RIDGE AVE., DEPT. OF RADIOLOGY, EVANSTON, IL 60201
(847) 570-2477
(847) 570-2942
Mailing address
2650 RIDGE AVE., DEPT. OF RADIOLOGY, EVANSTON, IL 60201
(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
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/26/2016
Last updated
04/08/2022
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