Healthcare Provider Details

I. General information

NPI: 1639052384
Provider Name (Legal Business Name): LYDIA DAOPUYE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST
URBANA IL
61801-2501
US

IV. Provider business mailing address

1359 N LINCOLN AVE APT 3075A
URBANA IL
61801-8605
US

V. Phone/Fax

Practice location:
  • Phone: 217-549-6585
  • Fax:
Mailing address:
  • Phone: 447-895-5548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.085968
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: