Provider Demographics
NPI:1720658248
Name:NAPERVILLE FAMILY CLINIC SC
Entity Type:Organization
Organization Name:NAPERVILLE FAMILY CLINIC SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNITA
Authorized Official - Middle Name:DERVESH
Authorized Official - Last Name:KOUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-991-7370
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:331-301-5170
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:515-991-7370
Practice Address - Fax:331-301-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center