Individual
VIVEK THAPPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1401 E STATE ST, ROCKFORD, IL 61104
(779) 696-6102
(779) 696-6026
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036081657
IL
207RP1001X
Pulmonary Disease Physician
036081657
IL
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
036081657
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036081657
—
IL
01
—
101-04711
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/04/2006
Last updated
02/19/2021
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