Provider Demographics
NPI:1033149208
Name:PULMONARY & CRITICAL CARE ASSOCIATES OF KANKAKEE LTD
Entity Type:Organization
Organization Name:PULMONARY & CRITICAL CARE ASSOCIATES OF KANKAKEE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AHAMED
Authorized Official - Middle Name:VP
Authorized Official - Last Name:KUTTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-933-3814
Mailing Address - Street 1:19 HERITAGE DR
Mailing Address - Street 2:STE 103
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1369
Mailing Address - Country:US
Mailing Address - Phone:815-933-3814
Mailing Address - Fax:815-933-3846
Practice Address - Street 1:19 HERITAGE DR
Practice Address - Street 2:STE 103
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1369
Practice Address - Country:US
Practice Address - Phone:815-933-3814
Practice Address - Fax:815-933-3846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
564910Medicare ID - Type Unspecified