Individual
DR. ROM MOHAN R KOPPARTHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1775 DEMPSTER ST, PARK RIDGE, IL 60068-1143
(847) 723-5313
(847) 723-2338
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
036069720
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036069720
ILLINOIS LICENSE
IL
05
—
036069720IL
—
IL
Enumeration date
10/01/2006
Last updated
03/05/2025
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