Benny Illickal

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

R37333 Issued in TX

Practice address

291 Stone Mountain Dr
Sunnyvale, TX 75182-2655

Phone

(972) 352-7260

NPI assigned

Sep 23, 2014

Last updated

Sep 23, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dynamic X-Ray Inc.

  • Radiologic Technologist
  • Dallas, TX
  • NPI 1811399678
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411430400000",
    "number": "1740682673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "291 STONE MOUNTAIN DR",
            "city": "SUNNYVALE",
            "state": "TX",
            "postal_code": "751822655",
            "telephone_number": "972-352-7260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "291 STONE MOUNTAIN DR",
            "city": "SUNNYVALE",
            "state": "TX",
            "postal_code": "751822655",
            "telephone_number": "972-352-7260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ILLICKAL",
        "first_name": "BENNY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-23",
        "last_updated": "2014-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "R37333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lesley Michelle Hooper
• Hospice Professionals Inc
• Andy Huang, DO
• Michael Steven Hunte, MD
• ICU and Respiratory Disease Consulting PA
• Infiniti Primary Healthcare LLC
• Innovative Emergency Physicians of Sunnyvale PA
• Interventional Pain & Aesthetics
• Mini Iype
• J R Rountree Enterprises, Inc. (Rountree Care Services)

• Diagnostic Radiology Physician in Sunnyvale, TX
• Providers in Sunnyvale, TX by specialty
• Diagnostic Radiology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.