Individual
BENNY ILLICKAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
291 STONE MOUNTAIN DR, SUNNYVALE, TX 75182-2655
(972) 352-7260
Mailing address
291 STONE MOUNTAIN DR, SUNNYVALE, TX 75182-2655
(972) 352-7260
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
R37333
TX
Other
Enumeration date
09/23/2014
Last updated
09/23/2014
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