Provider Demographics
NPI:1154328185
Name:SUNKARA, KRISHNA (MD)
Entity Type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:SUNKARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0967
Mailing Address - Country:US
Mailing Address - Phone:708-532-6029
Mailing Address - Fax:708-532-6095
Practice Address - Street 1:17680 KEDZIE AVE
Practice Address - Street 2:101
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2043
Practice Address - Country:US
Practice Address - Phone:708-799-7990
Practice Address - Fax:708-799-4093
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070359207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070359Medicaid
ILP00299331Medicare PIN
INM400058894Medicare PIN
ILD16038Medicare UPIN
IL036070359Medicaid