Healthcare Provider Details

I. General information

NPI: 1720658248
Provider Name (Legal Business Name): NAPERVILLE FAMILY CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2021
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 Number
License Number State

VIII. Authorized Official

Name: DR. SUNITA DERVESH KOUL
Title or Position: PRESIDENT
Credential: MD
Phone: 515-991-7370