Provider Demographics
NPI:1194720128
Name:KUPPUSWAMI, NARMADHA (MD)
Entity type:Individual
Prefix:DR
First Name:NARMADHA
Middle Name:
Last Name:KUPPUSWAMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 303, TOWER II
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-390-1240
Mailing Address - Fax:630-390-1247
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 303, TOWER II
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-390-1240
Practice Address - Fax:630-390-1247
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055594207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055594Medicaid
IL036055594Medicaid
ILK33253Medicare ID - Type Unspecified