Provider Demographics
NPI:1326338526
Name:ROY, SUDEEP (MD)
Entity Type:Individual
Prefix:
First Name:SUDEEP
Middle Name:
Last Name:ROY
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 1:2030 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4940
Mailing Address - Country:US
Mailing Address - Phone:650-814-0291
Mailing Address - Fax:877-967-3223
Practice Address - Street 1:1640 N ARLINGTON HEIGHTS RD STE 210
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3985
Practice Address - Country:US
Practice Address - Phone:877-967-3223
Practice Address - Fax:877-967-3223
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-10
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6786207YX0905X
IL036142018207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery