Provider Demographics
NPI:1285667550
Name:SUNITI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SUNITI MEDICAL CORPORATION
Other - Org Name:PREMIER ONCOLOGY HEMATOLOGY ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE 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 EAST 89TH AVENUE
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:
Practice Address - Street 1:200 EAST 89TH AVENUE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7319
Practice Address - Country:US
Practice Address - Phone:219-736-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100201480AMedicaid
IL91115213OtherBLUE SHIELD IL
CM0856OtherRR MEDICARE