Individual
TINOY KIZHAKEKUTTU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5405 N KNOXVILLE AVE, HEARTCARE MIDWEST, PEORIA, IL 61614-5016
(800) 352-4410
Mailing address
1324 N HICKORY HILLS RD, GERMANTOWN HILLS, IL 61548-9418
(309) 453-9581
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036110080
IL
207RC0000X
Cardiovascular Disease Physician
Primary
036-110080
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110080
—
IL
01
—
07215036
BCBS
IL
Enumeration date
02/17/2006
Last updated
01/24/2014
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