Individual
DR. ABHISH KOIRALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 988-6166
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 942-2171
(618) 988-6166
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
252423
MA
208M00000X
Hospitalist Physician
Primary
036141729
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
GROUP PTAN NUMBER
IL
Enumeration date
07/23/2012
Last updated
06/04/2021
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