Provider Demographics
NPI:1942293469
Name:PLAMOOTTIL, ISSAC G (MD)
Entity Type:Individual
Prefix:DR
First Name:ISSAC
Middle Name:G
Last Name:PLAMOOTTIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:150 QUAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-6142
Mailing Address - Country:US
Mailing Address - Phone:630-321-8300
Mailing Address - Fax:630-321-8750
Practice Address - Street 1:200 E FAIRMAN AVE
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1644
Practice Address - Country:US
Practice Address - Phone:630-321-8300
Practice Address - Fax:630-321-8750
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-077802207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-077802Medicaid
ILE25240Medicare UPIN