Provider Demographics
NPI:1659307189
Name:KOVILAM, OORMILA P (MD)
Entity Type:Individual
Prefix:
First Name:OORMILA
Middle Name:P
Last Name:KOVILAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OORMILA
Other - Middle Name:PADIKKAL
Other - Last Name:KOVILAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2529
Practice Address - Country:US
Practice Address - Phone:217-383-3140
Practice Address - Fax:217-383-4966
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-068843207V00000X, 207VC0200X, 207VM0101X
KY33384207V00000X, 207VC0200X, 207VM0101X
MI4301501713207V00000X, 207VM0101X
IL036125326207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VC0200XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyCritical Care Medicine
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0177599Medicaid
KY64959083Medicaid
OHKO0796035Medicare PIN
OH0177599Medicaid
G21958Medicare UPIN
OHKO4152272Medicare PIN