# ILLINOIS VALLEY EAR, NOSE & THROAT ASSOCIATES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316163926
- **Authorized official:** DR. BULENT MAMIKOGLU M.D. (PHYSICIAN)
- **Authorized official phone:** (815) 224-0082

## Contact information

- **Practice address:** 4231 PROGRESS BLVD STE 2, PERU, IL 61354-1193
- **Practice address phone:** (815) 224-0082
- **Practice address fax:** (815) 224-1071
- **Mailing address:** 4231 PROGRESS BLVD STE 2, PERU, IL 61354-1193
- **Mailing address phone:** (815) 224-0082
- **Mailing address fax:** (815) 224-1071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 207YX0901X | Otology & Neurotology Physician | — | NULL | — |
| 207YX0901X | Otology & Neurotology Physician | — | — | — |
| 261QM2500X | Medical Specialty Clinic/Center | 336-079161 | IL | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 01/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036117864-1 | — | IL |