Provider Demographics
NPI:1548520372
Name:TUTTLE, ADAM MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MICHAEL
Last Name:TUTTLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2452 N LAWNDALE AVE
Mailing Address - Street 2:APT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2341
Mailing Address - Country:US
Mailing Address - Phone:847-772-7420
Mailing Address - Fax:773-522-5855
Practice Address - Street 1:1401 S CALIFORNIA AVE
Practice Address - Street 2:4TH FLOOR RESIDENCY OFFICE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-1858
Practice Address - Country:US
Practice Address - Phone:773-522-5853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125057943208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation