Organization
ILLINOIS VALLEY EAR, NOSE & THROAT ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BULENT MAMIKOGLU M.D. (PHYSICIAN)
(815) 224-0082
Entity
Organization
Contact information
Practice address
4231 PROGRESS BLVD STE 2, PERU, IL 61354-1193
(815) 224-0082
(815) 224-1071
Mailing address
4231 PROGRESS BLVD STE 2, PERU, IL 61354-1193
(815) 224-0082
(815) 224-1071
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
—
—
207YX0901X
Otology & Neurotology Physician
—
—
261QM2500X
Medical Specialty Clinic/Center
Primary
336-079161
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036117864-1
—
IL
Enumeration date
04/18/2007
Last updated
01/22/2020
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