1861982597 NPI number — KEVIN THENGUMTHARAYIL MATHEW DO

Table of content: KEVIN THENGUMTHARAYIL MATHEW DO (NPI 1861982597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861982597 NPI number — KEVIN THENGUMTHARAYIL MATHEW DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEW
Provider First Name:
KEVIN
Provider Middle Name:
THENGUMTHARAYIL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861982597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 713160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-292-3151
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 E. BRUSH HILL RD.
Provider Second Line Business Practice Location Address:
DEPARTMENT OF RADIOLOGY
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60126-5658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-221-5420
Provider Business Practice Location Address Fax Number:
331-221-3701
Provider Enumeration Date:
05/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  U2564 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 036167646 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com