Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 36.132608 | IL |
Y | 111NI0900X | Internist | 36.132608 | IL |
N | 207R00000X | Internist | 40461 | IA |
N | 111NI0900X | Internist | 40461 | IA |
NPI | 1003127895 |
---|---|
Provider Name | Dr. Sunita Dervesh Koul |
First Address | Livonia, MI 48150-1216 |
Second Address | Hinsdale, IL 60521-2926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2010 |
Last Update Date | 17/05/2018 |