Provider Demographics
NPI:1982847810
Name:NANDANAN MOORTHIE, MYDHILI (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MYDHILI
Middle Name:
Last Name:NANDANAN MOORTHIE
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MYDHILI
Other - Middle Name:
Other - Last Name:MOORTHIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:4119 HONEY LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-1113
Mailing Address - Country:US
Mailing Address - Phone:312-593-7438
Mailing Address - Fax:
Practice Address - Street 1:885 ROOSEVELT RD STE 100
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6141
Practice Address - Country:US
Practice Address - Phone:630-384-6200
Practice Address - Fax:630-384-6229
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036129528207Q00000X
IN01092376A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102594807OtherANTHEM
IN300085119Medicaid