Organization
PRANA CENTER FOR ASTHMA AND ALLERGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMYUKTA KOPPULA MD (OWNER)
(630) 323-8800
Entity
Organization
Contact information
Practice address
6857 KINGERY HIGHWAY, WILLOWBROOK, IL 60527
(630) 323-8800
Mailing address
6714 FIELDSTONE DR, BURR RIDGE, IL 60527
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
036078244
IL
Other
Enumeration date
04/11/2007
Last updated
01/20/2009
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