Bopanna, Suraj

Bopanna, Suraj is an individual health care provider with primary practice located at 1401 E State St , Rockford IL 61104. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Pulmonary Disease is his primary health care specialty. Bopanna, Suraj can be contacted via phone (779) 696-6102.

Contact Information

Primary practice address
1401 E State St Rockford IL 61104
Phone: (779) 696-6102
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 40265 Iowa
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 40265 Iowa
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 40265 Iowa
Allopathic & Osteopathic Physicians / Pulmonary Disease 207RP1001X 036-126456 Illinois
Allopathic & Osteopathic Physicians / Critical Care Medicine 207RC0200X 036-126456 Illinois

Profile Details

NPI number 1740433291
LBN Legal business name Bopanna, Suraj
Credentials MD, MRCP
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 28th, 2008
Last updated Mar 4th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1740433291 NPPES
Wisconsin MEDICAID 100181898

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