Healthcare Provider Details

I. General information

NPI: 1003127895
Provider Name (Legal Business Name): DR. SUNITA DERVESH KOUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1879 BAY SCOTT CIR STE 111
NAPERVILLE IL
60540-1109
US

IV. Provider business mailing address

1879 BAY SCOTT CIR STE 111
NAPERVILLE IL
60540-1109
US

V. Phone/Fax

Practice location:
  • Phone: 630-961-1341
  • Fax: 630-961-1782
Mailing address:
  • Phone: 515-991-7370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36.132608
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036132608
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: