Provider Demographics
NPI:1003127895
Name:KOUL, SUNITA DERVESH
Entity type:Individual
Prefix:DR
First Name:SUNITA
Middle Name:DERVESH
Last Name:KOUL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 DANLAUR CT
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4213
Mailing Address - Country:US
Mailing Address - Phone:515-991-7370
Mailing Address - Fax:
Practice Address - Street 1:1831 BAY SCOTT CIR STE 109
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1115
Practice Address - Country:US
Practice Address - Phone:630-961-1341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-25
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036132608208M00000X, 208M00000X
IL36.132608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine