Provider Demographics
NPI:1215127212
Name:KAUL, MONIKA DULLO (MD)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:DULLO
Last Name:KAUL
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 1:828 NE GLEN OAK AVE
Mailing Address - Street 2:#105
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3285
Mailing Address - Country:US
Mailing Address - Phone:309-676-5844
Mailing Address - Fax:
Practice Address - Street 1:828 NE GLEN OAK AVE
Practice Address - Street 2:#105
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3285
Practice Address - Country:US
Practice Address - Phone:309-676-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics