Provider Demographics
NPI:1649460767
Name:VICTORIA KUT MD LTD
Entity type:Organization
Organization Name:VICTORIA KUT MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-977-1212
Mailing Address - Street 1:1255 WINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1160
Mailing Address - Country:US
Mailing Address - Phone:847-977-1212
Mailing Address - Fax:847-342-0378
Practice Address - Street 1:660 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1659
Practice Address - Country:US
Practice Address - Phone:847-977-1212
Practice Address - Fax:847-342-0378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4932738OtherBLUE CROSS BLUE SHIELD
ILG55341Medicare UPIN
IL215616Medicare PIN