Provider Demographics
NPI:1275973539
Name:KOEPPEL, ROSEMARY TAKYI (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:TAKYI
Last Name:KOEPPEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:TAKYI
Other - Last Name:OWUSU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:217-243-0300
Mailing Address - Fax:217-245-6775
Practice Address - Street 1:15 FOUNDERS LN
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3919
Practice Address - Country:US
Practice Address - Phone:217-243-0300
Practice Address - Fax:217-245-6775
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140103208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics