1245221837 NPI number — SUDHEER PARUCHURI MD

Table of content: SUDHEER PARUCHURI MD (NPI 1245221837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245221837 NPI number — SUDHEER PARUCHURI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARUCHURI
Provider First Name:
SUDHEER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245221837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 E. WATERSIDE DRIVE #2912
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO,IL
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-622-7622
Provider Business Mailing Address Fax Number:
312-924-5924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N HARLEM AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60302-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-473-4748
Provider Business Practice Location Address Fax Number:
312-924-5924
Provider Enumeration Date:
11/02/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  036110857 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 036110857 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)