Provider Demographics
NPI:1780106997
Name:VERMA, NUPUR (MD)
Entity type:Individual
Prefix:
First Name:NUPUR
Middle Name:
Last Name:VERMA
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 1:2981 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-3259
Mailing Address - Country:US
Mailing Address - Phone:217-877-9775
Mailing Address - Fax:217-877-9806
Practice Address - Street 1:2965 N MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-4392
Practice Address - Country:US
Practice Address - Phone:217-875-7847
Practice Address - Fax:217-875-7890
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-070582390200000X
IL036151458207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program