Individual
DR. BONEY MATTATHETHU NINAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1900 W POLK ST, MEDICINE, CHICAGO, IL 60612-3723
(312) 864-7203
Mailing address
1548 W HARRISON ST, APT 3 B, CHICAGO, IL 60607-3169
(630) 398-1030
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125057406
IL
Other
Enumeration date
09/09/2010
Last updated
11/30/2021
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