Provider Demographics
NPI:1881806255
Name:KURUVILLA, ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:KURUVILLA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 W MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1057
Mailing Address - Country:US
Mailing Address - Phone:313-744-0549
Mailing Address - Fax:248-918-0229
Practice Address - Street 1:8333 W MAYNARD RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1057
Practice Address - Country:US
Practice Address - Phone:313-744-0549
Practice Address - Fax:248-918-0229
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036332A2084N0400X
IL0360734732084N0400X
IL036-0734732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGOtherMEDICARE
FLPENDINGMedicaid
IN300050303Medicaid
IN300050303Medicaid
FLPENDINGMedicaid