Individual
LAURA KOEPPEL TAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2900 FOXFIELD RD, ST CHARLES, IL 60174-5799
(630) 208-3200
(630) 208-3201
Mailing address
2900 FOXFIELD RD, ST CHARLES, IL 60174-5799
(630) 208-3200
(630) 208-3201
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036138795
IL
207R00000X
Internal Medicine Physician
2008-00673
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053440008
—
NC
05
—
5909695
—
NC
01
—
920540
MEDICARE PTAN - GROUP
IL
01
—
F400237969
MEDICARE PTAN - INDIVIDUAL
IL
05
—
N0067F
—
SC
Enumeration date
03/05/2007
Last updated
09/16/2015
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