Provider Demographics
NPI:1831210814
Name:HANUMADASS, MARELLA L (MD)
Entity type:Individual
Prefix:DR
First Name:MARELLA
Middle Name:L
Last Name:HANUMADASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:227 WOOD GLEN LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1530
Mailing Address - Country:US
Mailing Address - Phone:630-530-4052
Mailing Address - Fax:630-530-4173
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3166
Practice Address - Fax:312-864-9545
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery