Provider Demographics
NPI:1245877471
Name:KANJOOKARAN, CYRIL T
Entity type:Individual
Prefix:
First Name:CYRIL
Middle Name:T
Last Name:KANJOOKARAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 GREEN BAY RD # 202
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1701
Mailing Address - Country:US
Mailing Address - Phone:847-447-6040
Mailing Address - Fax:
Practice Address - Street 1:914 GREEN BAY RD # 202
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1701
Practice Address - Country:US
Practice Address - Phone:847-447-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-06
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070024899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist