Provider Demographics
NPI:1497913651
Name:EAPEN, BETSY MALICAKAL (DO)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:MALICAKAL
Last Name:EAPEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1243 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-4531
Mailing Address - Country:US
Mailing Address - Phone:917-348-4769
Mailing Address - Fax:224-238-7780
Practice Address - Street 1:1243 TUSCANY DR
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-4531
Practice Address - Country:US
Practice Address - Phone:917-348-4769
Practice Address - Fax:224-238-7780
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-23
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-125071207RN0300X
GA065357207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology