Provider Demographics
NPI:1699721142
Name:MADAPPALLIL, MEERA GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:MEERA
Middle Name:GEORGE
Last Name:MADAPPALLIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8345 W MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1058
Mailing Address - Country:US
Mailing Address - Phone:847-983-4215
Mailing Address - Fax:847-983-9215
Practice Address - Street 1:2425 W 22ND ST
Practice Address - Street 2:SUITE: 211
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1245
Practice Address - Country:US
Practice Address - Phone:630-368-3909
Practice Address - Fax:630-368-3958
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104910Medicaid
IL209857OtherMEDICARE PTAN FOR DUPAGE COUNTY
IL209858OtherMEDICARE PTAN FOR COOK COUNTY
ILH50193Medicare UPIN