Provider Demographics
NPI:1598762262
Name:CHOPRA, KAMAL K (MD)
Entity Type:Individual
Prefix:MR
First Name:KAMAL
Middle Name:K
Last Name:CHOPRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1021
Mailing Address - Country:US
Mailing Address - Phone:217-854-9411
Mailing Address - Fax:217-854-2858
Practice Address - Street 1:604 N BROAD ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1021
Practice Address - Country:US
Practice Address - Phone:217-854-9411
Practice Address - Fax:217-854-2858
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-057724207Q00000X
IL036057724207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371406119001Medicaid
IL036057724Medicaid
IL143937Medicare Oscar/Certification
IL624840Medicare PIN
IL036057724Medicaid
IL148978Medicare Oscar/Certification