Provider Demographics
NPI:1134215569
Name:MOOLAYIL, KUMAR DAMODARAN (MD)
Entity type:Individual
Prefix:
First Name:KUMAR
Middle Name:DAMODARAN
Last Name:MOOLAYIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SAINT MICHAEL CT
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2556
Mailing Address - Country:US
Mailing Address - Phone:708-214-9349
Mailing Address - Fax:630-986-8390
Practice Address - Street 1:200 SAINT MICHAEL CT
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2556
Practice Address - Country:US
Practice Address - Phone:708-214-9349
Practice Address - Fax:630-986-8390
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360581282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058128Medicaid
677910Medicare ID - Type Unspecified