MEDICARE: RAFIQ M KUTTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036111644	IL
2	207RP1001X	Pulmonary Disease Physician	036-111644	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202964	OTHER	IL	MEDICARE
4	202963	OTHER	IL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	31601838	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114112612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFIQ M KUTTY MD

Provider Business Mailing Address
First Line	:	675 W NORTH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1634
Country	:	US
Telephone Number	:	708-366-7177
Fax Number	:	708-366-3301

Provider Business Practice Location Address
First Line	:	7607 W MADISON AVE
Second Line	:
City	:	FOREST PARK
State	:	IL
Zip	:	60130-3513
Country	:	US
Telephone Number	:	708-366-7177
Fax Number	:	708-366-3301

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2007
Last Update Date	:	01/27/2012

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Directions to “ RAFIQ M KUTTY MD” Practice Location

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