Provider Demographics
NPI:1245221837
Name:PARUCHURI, SUDHEER (MD)
Entity Type:Individual
Prefix:
First Name:SUDHEER
Middle Name:
Last Name:PARUCHURI
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 1:420 E. WATERSIDE DRIVE #2912
Mailing Address - Street 2:
Mailing Address - City:CHICAGO,IL
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-622-7622
Mailing Address - Fax:312-924-5924
Practice Address - Street 1:1515 N HARLEM AVE STE 100
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1205
Practice Address - Country:US
Practice Address - Phone:312-473-4748
Practice Address - Fax:312-924-5924
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361108572085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100243997Medicare Oscar/Certification
INI43528Medicare UPIN