Individual
KOODATHUMMURIEL EAPPEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1634 W POLK ST, CHICAGO, IL 60612-4352
(312) 829-4224
Mailing address
1335 S PRAIRIE AVE UNIT 1406, CHICAGO, IL 60605-3137
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
IL
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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