Individual
BHASKER RAO KOPPULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050-8409
(815) 334-5566
(815) 759-4008
Mailing address
DEPARTMENT OF RADIOLOGY UNIVERSITY OF UTAH, 30 NORTH 1900 EAST, #1A071, SALT LAKE CITY, UT 84132-2140
(801) 581-7553
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
7682213-1205
UT
2085R0202X
Diagnostic Radiology Physician
Primary
036166661
IL
2085R0202X
Diagnostic Radiology Physician
7682213-1205
UT
2085R0202X
Diagnostic Radiology Physician
MD60120325
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
339350
INTERNAL ID-MOTOR VEHICLE ID
—
05
—
8443277
—
WA
Enumeration date
10/27/2006
Last updated
08/30/2024
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