Active NPI
Stephen K Mekkattil
- Critical Care Medicine Registered Nurse
- Oshkosh, WI
National Provider Identifier
1801615331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Care Medicine Registered Nurse
- License
- 1104909
- Practice address
- 835 Merritt Ave Apt 103
Oshkosh, WI 54901-5373 - Phone
- (516) 830-0480
- NPI assigned
- Oct 10, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | 1104909 | WI | Primary |
Addresses
Primary practice location
835 Merritt Ave Apt 103
Oshkosh, WI 54901-5373
Mailing address
835 Merritt Ave Apt 103
Oshkosh, WI 54901-5373
Phone (516) 830-0480
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1104909 | WI | MD | Critical Care Medicine Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1728518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1801615331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "835 MERRITT AVE APT 103",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549015373",
"telephone_number": "516-830-0480"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "835 MERRITT AVE APT 103",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549015373",
"telephone_number": "516-830-0480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEKKATTIL",
"first_name": "STEPHEN",
"middle_name": "K",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-10",
"last_updated": "2024-10-10",
"certification_date": "2024-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "163WC0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Critical Care Medicine",
"state": "WI",
"license": "1104909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.