Provider Demographics
NPI:1265641195
Name:SUNITI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SUNITI MEDICAL CORPORATION
Other - Org Name:PREMIER ONCOLOGY HEMATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-736-2800
Mailing Address - Street 1:200 E 89TH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7319
Mailing Address - Country:US
Mailing Address - Phone:219-736-2800
Mailing Address - Fax:219-736-6680
Practice Address - Street 1:929 RIDGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1751
Practice Address - Country:US
Practice Address - Phone:219-836-2000
Practice Address - Fax:219-836-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0448072681OtherIL MEDICAID
IL91115213OtherBCBS IL
IN100201480AMedicaid
INCM0856OtherRAILROAD MEDICARE