Basic Information
| Provider Information | |||||||||
| NPI: | 1235864059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPURI | ||||||||
| FirstName: | SOWMYA BHASHINI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3249 OAK PARK AVE | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604023429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087833401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3722 HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605462312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087836566 | ||||||||
| FaxNumber: | 7087836567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2022 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125080528 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.