Individual
RAFIQ M KUTTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7607 W MADISON AVE, FOREST PARK, IL 60130-3513
(708) 366-7177
(708) 366-3301
Mailing address
675 W NORTH AVE, MELROSE PARK, IL 60160-1634
(708) 366-7177
(708) 366-3301
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036111644
IL
207RP1001X
Pulmonary Disease Physician
Primary
036-111644
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036111644
—
IL
01
—
202963
MEDICARE
IL
01
—
202964
MEDICARE
IL
01
—
31601838
BLUE CROSS BLUE SHIELD
IL
Enumeration date
09/09/2007
Last updated
01/27/2012
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