Provider Demographics
NPI:1659754422
Name:JOHN KATTOOR, AJOE (MBBS)
Entity Type:Individual
Prefix:
First Name:AJOE
Middle Name:
Last Name:JOHN KATTOOR
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:AJOE
Other - Middle Name:
Other - Last Name:KATTOOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1201 W ADAMS ST APT 701
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2898
Mailing Address - Country:US
Mailing Address - Phone:501-613-2868
Mailing Address - Fax:
Practice Address - Street 1:1331 STATE ST STE 140
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3112
Practice Address - Country:US
Practice Address - Phone:219-324-0014
Practice Address - Fax:219-324-0025
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144990207RC0000X, 207RI0011X
NY316618207RI0011X
390200000X
IN01089745A207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program