Individual
KEVIN THENGUMTHARAYIL MATHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
155 E. BRUSH HILL RD., DEPARTMENT OF RADIOLOGY, ELMHURST, IL 60126-5658
(331) 221-5420
(331) 221-3701
Mailing address
PO BOX 713160, CHICAGO, IL 60677-0360
(262) 292-3151
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036167646
IL
2085R0202X
Diagnostic Radiology Physician
U2564
TX
Other
Enumeration date
05/17/2018
Last updated
04/10/2025
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