Suparna Kohli, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036123811 Issued in IL

Practice address

2300 N Edward St
Internal Medicine
Decatur, IL 62526-4163

Phone

(217) 876-4360

Fax

(217) 876-4365

NPI assigned

Jul 17, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301011200000",
    "number": "1629277801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "address_2": "INTERNAL MEDICINE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-4360",
            "fax_number": "217-876-4365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "address_2": "INTERNAL MEDICINE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-4360",
            "fax_number": "217-876-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOHLI",
        "first_name": "SUPARNA",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-17",
        "last_updated": "2011-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036123811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Knobeloch, PSY.D.
• Sherrie Knutson, ATC
• Michael Stephen Koch, MS, ATC
• Kaitlyn P Kohler, NP
• Manoj Kohli, MD
• Manohar Kola, M.D.
• Jamie Kolovadis
• Elizabeth Komnick, P.T.
• Kasandra Koons, CF-SLP
• Alicia Koontz

• Internal Medicine Physician in Decatur, IL
• Providers in Decatur, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.