Provider Demographics
NPI:1114986650
Name:SUNDARESAN, GAYATHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYATHRI
Middle Name:
Last Name:SUNDARESAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1730 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2688
Mailing Address - Country:US
Mailing Address - Phone:630-718-0200
Mailing Address - Fax:630-718-0900
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:ROOM 607
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-3456
Practice Address - Fax:773-296-3622
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF87288Medicare UPIN