Provider Demographics
NPI:1073834453
Name:TUTUNIKOV, IRINA (DO)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:TUTUNIKOV
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PATRIOT BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8021
Mailing Address - Country:US
Mailing Address - Phone:847-232-9932
Mailing Address - Fax:847-262-4077
Practice Address - Street 1:2700 PATRIOT BLVD
Practice Address - Street 2:SUUITE 250
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8021
Practice Address - Country:US
Practice Address - Phone:847-232-9932
Practice Address - Fax:847-262-4077
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132626207R00000X
PAOS015787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine