Provider Demographics
NPI:1679554034
Name:TUTTLE, RICHARD S (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 W SALT CREEK LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5001
Mailing Address - Country:US
Mailing Address - Phone:847-870-4200
Mailing Address - Fax:847-870-0059
Practice Address - Street 1:3030 W SALT CREEK LN
Practice Address - Street 2:SUITE 100
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5001
Practice Address - Country:US
Practice Address - Phone:847-870-4200
Practice Address - Fax:847-870-0059
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088155208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360881551Medicaid
IL01634499OtherBCBS
ILL29984Medicare PIN
ILF74384Medicare UPIN
IL0360881551Medicaid