Provider Demographics
NPI:1497208573
Name:KUTLU, MEHMET TALHA (MD)
Entity Type:Individual
Prefix:MR
First Name:MEHMET TALHA
Middle Name:
Last Name:KUTLU
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 1:1134 W GRANVILLE AVE APT 902
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-5050
Mailing Address - Country:US
Mailing Address - Phone:773-682-9743
Mailing Address - Fax:
Practice Address - Street 1:4646 N MARINE
Practice Address - Street 2:DR WEISS MEMORIAL HOSPITAL
Practice Address - City:CHCIAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-878-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.067999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine