Provider Demographics
NPI:1568881225
Name:PLAMOOTTIL, CHERIAN ISSAC (DO)
Entity Type:Individual
Prefix:
First Name:CHERIAN
Middle Name:ISSAC
Last Name:PLAMOOTTIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4248
Mailing Address - Fax:317-865-8314
Practice Address - Street 1:211 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-1696
Practice Address - Country:US
Practice Address - Phone:708-755-7069
Practice Address - Fax:708-755-7640
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036143413207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program