Individual
SAMYUKTA KOPPULA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6857 KINGERY HWY, WILLOWBROOK, IL 60527-5114
(630) 323-8800
(630) 850-9797
Mailing address
6857 KINGERY HWY, WILLOWBROOK, IL 60527-5114
(630) 323-8800
(630) 850-9797
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
00303660782441
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003-036-078244-1
STATE OF IL LICENCE
IL
01
—
2233164
BCBS OF ILLINOIS
IL
Enumeration date
12/04/2006
Last updated
09/30/2013
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