Active NPI
Lea Fucydzy Kioutas, M.D.
- General Practice Physician
- Huntley, IL
National Provider Identifier
1316277569
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 36-054274
- Practice address
- 13100 Vineyard Dr
Huntley, IL 60142 - Phone
- (847) 814-4007
- Fax
- (847) 814-4007
- NPI assigned
- Jan 12, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 36-054274 | IL | Primary |
Addresses
Primary practice location
13100 Vineyard Dr
Huntley, IL 60142
Mailing address
13100 Vineyard Dr
Huntley, IL 60142
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36-054274 | IL | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1263254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1263254400000",
"number": "1316277569",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13100 VINEYARD DR",
"city": "HUNTLEY",
"state": "IL",
"postal_code": "60142"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13100 VINEYARD DR",
"city": "HUNTLEY",
"state": "IL",
"postal_code": "60142",
"telephone_number": "847-814-4007",
"fax_number": "847-814-4007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIOUTAS",
"first_name": "LEA",
"middle_name": "FUCYDZY",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-01-12",
"last_updated": "2010-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "IL",
"license": "36-054274",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntley, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.