Provider Demographics
NPI:1578554911
Name:KURUP, PARVATHY D (MD)
Entity Type:Individual
Prefix:DR
First Name:PARVATHY
Middle Name:D
Last Name:KURUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 379
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-0379
Mailing Address - Country:US
Mailing Address - Phone:708-460-9833
Mailing Address - Fax:708-460-1117
Practice Address - Street 1:95 N GREENLEAF ST
Practice Address - Street 2:SUITE A
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3309
Practice Address - Country:US
Practice Address - Phone:847-623-2114
Practice Address - Fax:847-623-4628
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360582502085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920007668OtherRR MEDICARE ADVANCED RAD
ILCK9135OtherRR MEDICARE ADV RAD GR#
IL04932214OtherBCBSIL ROTATING GAMMA
IL01633381OtherBCBIL ADVANCED RAD
1902897358OtherROT GAMMA NPI#
1548251986OtherADV RAD NPI #
ILP00042094OtherRR MEDICARE ROT GMA
IL036058250Medicaid
ILDA2626OtherRR MEDICARE ROT GMA GR#
IL04932214OtherBCBSIL ROTATING GAMMA
ILL97120Medicare UPIN
IL204949Medicare ID - Type UnspecifiedADVANCED RAD GROUP#
IL01633381OtherBCBIL ADVANCED RAD