Provider Demographics
NPI:1598412884
Name:KALAYIL, AJIT THOMAS (APRN)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:THOMAS
Last Name:KALAYIL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 N LAKE SHORE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5302
Mailing Address - Country:US
Mailing Address - Phone:312-340-4523
Mailing Address - Fax:
Practice Address - Street 1:3660 N LAKE SHORE DR STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5302
Practice Address - Country:US
Practice Address - Phone:312-340-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024879363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health