SAMYUKTA KOPPULA (NPI# 1770641763) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770641763 |
| Entity Type | Individual |
| Full Name | SAMYUKTA KOPPULA |
| Credential | M.D. |
| Practice Address |
6857 Kingery Hwy Willowbrook IL 60527-5114 |
| Practice Telephone | 6303238800 |
| Practice Fax Number | 6308509797 |
| Mailing Telephone | 6303238800 |
| Mailing Fax Number | 6308509797 |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2013-09-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | 00303660782441 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE OF IL LICENCE | 003-036-078244-1 | 01 |
| IL | BCBS OF ILLINOIS | 2233164 | 01 |
| Street Address |
6857 KINGERY HWY |
| City | WILLOWBROOK |
| State | IL |
| Zip Code | 60527-5114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023635364 | Crystal Mary Dirks | Occupational Therapy Assistant | 211 75th St, Burr Ridge, IL 60527 | 2020-07-02 |
| 1386276350 | Valerie Moreno-tucker | Counselor | 277 83rd St, Burr Ridge, Il 60527, Burr Ridge, IL 60527 | 2020-02-07 |
| 1831734763 | Annette Maria Zajac | Occupational Therapist | 16 91st St., Burr Ridge, IL 60527 | 2019-11-14 |
| 1568023109 | Jennifer Rogers | Counselor | 277 83rd St., Ste. D, Burr Ridge, IL 60527 | 2019-06-25 |
| 1710458526 | Dima Sibai Dds PC | Clinic/Center | 940 Plianfield Rd., Willowbrook, IL 60527 | 2018-12-06 |
| 1558850495 | Jeanie C. Lucy PC | Optometrist | 6340 Americana Drive Suite 1108, Willowbrook, IL 60527 | 2018-05-07 |
| 1538664032 | Athletico,ltd | Physical Therapist | 6860 N Frontage Rd Ste B, Burr Ridge, IL 60527 | 2018-03-27 |
| 1003314832 | Ams Wellness Pllc | Psychologist | 277 83rd St Ste D, Burr Ridge, IL 60527 | 2018-01-26 |
| 1023564671 | Natasa Manasovska | Dentist | 6111 Knollwood Rd, Apt. 103, Willowbrook, IL 60527 | 2016-09-01 |
| 1669927893 | Marie Ann Korallus | Nurse Practitioner | 7055 High Grove, Burr Ridge, IL 60527 | 2016-08-17 |
| Find all providers in zip 60527 | ||||
| Taxonomy Code | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821211491 | Prana Center for Asthma and Allergy LLC | Allergy & Immunology | 6857 Kingery Highway, Willowbrook, IL 60527 | 2007-04-11 |
| 1346650439 | Midwest Allergy & Asthma Clinic LLC | Allergy & Immunology | 6827 Kingery Hwy, Willowbrook, IL 60527-5154 | 2014-04-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649749813 | Thao T Doan | Allergy & Immunology | 523 Sandy Ln, Libertyville, IL 60048-3553 | 2018-11-17 |
| 1275063695 | Chicago Allergy & Asthma, LLC | Allergy & Immunology | 7447 W Talcott Ave Ste 308, Chicago, IL 60631-3714 | 2017-06-18 |
| 1982022810 | Kirk Van Shepard II | Allergy & Immunology | 3000 N Halsted St Ste 400, Chicago, IL 60657-8480 | 2014-03-28 |
| 1790102176 | Jennifer Christine Simonaire | Allergy & Immunology | 908 N Elm St Ste 205, Hinsdale, IL 60521-3637 | 2014-03-24 |
| 1558794446 | Sarah M Boudreau-romano | Allergy & Immunology | 1300 N Lake Shore Dr Apt 3a, Chicago, IL 60610-2157 | 2013-08-14 |
| 1821420209 | Donald Ernest Temple | Allergy & Immunology | 110 E Delaware Pl, Chicago, IL 60611-1481 | 2013-08-07 |
| 1013259647 | Melissa Lee Robinson | Allergy & Immunology | 430 Pennsylvania Ave Ste 220, Glen Ellyn, IL 60137 | 2013-03-21 |
| 1871859645 | Sarah Garon | Allergy & Immunology | 1460 N Halsted St Ste 506, Chicago, IL 60642-2605 | 2012-04-06 |
| 1386919421 | Henry J. Dold | Allergy & Immunology | 1300 Kenilworth Av, Glenview, IL 60025-2204 | 2012-03-21 |
| 1386919538 | Diosdado T Lim | Allergy & Immunology | 7520 W. Ute Ln, Palos Heights, IL 60463-2076 | 2012-03-20 |
| Find all providers with the same taxonomy | ||||
| City | WILLOWBROOK |
| Zip Code | 60527 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.