| Doctor Name: | BISSY KUMPUCKAL |
| NPI Number: | 1053784645 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 209013257 |
| Business Practice Address: | 2213 Hamilton Ln Darien, IL - 605614346 |
| Business Phone Number: | 6306896553 |
| Business Fax Number: | |
| Mailing Address: | 1333 Butterfield Rd, Ste 130 DOWNERS GROVE |
| State: | IL |
| Postal Code: | 605155641 |
| Phone Number: | 6303710133 |
| Fax Number: | 6303710138 |
| NPI Enumeration Date: | 11/05/2015 |
| NPI Last Update Date: | 01/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209013257 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |