Healthcare Provider Details

I. General information

NPI: 1881877686
Provider Name (Legal Business Name): VIVEK THAPPA, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 N MULFORD RD SUITE 100
ROCKFORD IL
61107-3879
US

IV. Provider business mailing address

PO BOX 5023
ROCKFORD IL
61125-0023
US

V. Phone/Fax

Practice location:
  • Phone: 815-316-1899
  • Fax: 815-316-1897
Mailing address:
  • Phone: 815-316-1899
  • Fax: 815-316-1897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036081657
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number036081657
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036081657
License Number StateIL

VIII. Authorized Official

Name: VIVEK THAPPA
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 815-316-1899