Provider Demographics
NPI:1881624054
Name:KUTTY, AHAMED VP (MD)
Entity type:Individual
Prefix:DR
First Name:AHAMED
Middle Name:VP
Last Name:KUTTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:19 HERITAGE DR
Mailing Address - Street 2:STE 105
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1369
Mailing Address - Country:US
Mailing Address - Phone:815-933-3814
Mailing Address - Fax:815-933-3846
Practice Address - Street 1:19 HERITAGE DR
Practice Address - Street 2:STE 105
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1369
Practice Address - Country:US
Practice Address - Phone:815-933-3814
Practice Address - Fax:815-933-3846
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0030360527671207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052767Medicaid
IL036052767Medicaid
C38059Medicare UPIN