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General NPI Number Information
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NPI Number | 1720658248
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Entity Type | Organization
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Legal Business Name | NAPERVILLE FAMILY CLINIC SC
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1879 BAY SCOTT CIR STE 111
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City | NAPERVILLE
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State | IL
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Zip | 60540-1109
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Country | US
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Telephone | 630-961-1341
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Fax | 630-961-1782
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Provider Business Mailing Address
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Address Line | 3319 DANLAUR CT
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City | NAPERVILLE
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State | IL
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Zip | 60564-4213
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Country | US
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Telephone | 515-991-7370
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Fax | 331-301-5170
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUNITA DERVESH KOUL
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Credential | MD
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Telephone | 515-991-7370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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