Provider Demographics
NPI:1154372845
Name:RUPANI, SUJAYA P (MD)
Entity type:Individual
Prefix:
First Name:SUJAYA
Middle Name:P
Last Name:RUPANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9380 CASCADE CIR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0712
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:396 REMINGTON BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-3466
Practice Address - Country:US
Practice Address - Phone:630-759-9800
Practice Address - Fax:630-759-9858
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036065223207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04778Medicare UPIN