Provider Demographics
NPI:1417016874
Name:KRISHNANKUTTY, KUTTOPPILLY N (MD)
Entity Type:Individual
Prefix:
First Name:KUTTOPPILLY
Middle Name:N
Last Name:KRISHNANKUTTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD ROAD
Mailing Address - Street 2:WIMMER MEDICAL PLAZA #203
Mailing Address - City:ELK GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7322
Mailing Address - Country:US
Mailing Address - Phone:847-593-5420
Mailing Address - Fax:847-956-5106
Practice Address - Street 1:800 BIESTERFIELD ROAD
Practice Address - Street 2:WIMMER MEDICAL PLAZA #203
Practice Address - City:ELK GROVE
Practice Address - State:IL
Practice Address - Zip Code:60007-7322
Practice Address - Country:US
Practice Address - Phone:847-593-5420
Practice Address - Fax:847-956-5106
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050301207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050301Medicaid
C42366Medicare UPIN
492452Medicare ID - Type Unspecified