Provider Demographics
NPI:1750537817
Name:MUTHIAH, CHETHRA KALA (MD)
Entity type:Individual
Prefix:
First Name:CHETHRA
Middle Name:KALA
Last Name:MUTHIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 3900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1214
Mailing Address - Country:US
Mailing Address - Phone:847-657-5959
Mailing Address - Fax:847-657-5764
Practice Address - Street 1:9650 GROSS POINT RD STE 3900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-657-5959
Practice Address - Fax:847-657-5764
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036125080207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125080Medicaid
IL347713027OtherMEDICARE PTAN MCHENRY COUNTY
IL347711013OtherMEDICARE PTAN DUPAGE COUNTY
IL347710032OtherMEDICARE PTAN COOK COUNTY
ILIL3289018OtherMEDICARE PTAN WILL COUNTY