Provider Demographics
NPI:1093940611
Name:KIZHAKEPUNNUR, LENNEY G (MD)
Entity Type:Individual
Prefix:DR
First Name:LENNEY
Middle Name:G
Last Name:KIZHAKEPUNNUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2202 HARLEM RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-654-5342
Practice Address - Street 1:2202 HARLEM RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-654-5342
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-055883207L00000X
IL036.130345207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology