Provider Demographics
NPI:1669422333
Name:CUTINELLO, ANTHONY JOHN JR (DO)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:CUTINELLO
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SAINT CLARE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9239
Mailing Address - Country:US
Mailing Address - Phone:309-886-4000
Mailing Address - Fax:
Practice Address - Street 1:10 SAINT CLARE CT STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9239
Practice Address - Country:US
Practice Address - Phone:309-886-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2917207Q00000X
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00433546OtherRR INDIVIDUAL #
ILCA4079OtherRR GROUP
AZ358970Medicaid
ILCA4079OtherRR GROUP
IL809840Medicare ID - Type UnspecifiedGROUP #
AZ358970Medicaid
ILP00433546OtherRR INDIVIDUAL #