Provider Demographics
NPI:1427017961
Name:R. SUNDARESAN, MD, SC
Entity Type:Organization
Organization Name:R. SUNDARESAN, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAMOORTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARESAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-718-0200
Mailing Address - Street 1:1730 PARK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2688
Mailing Address - Country:US
Mailing Address - Phone:630-718-0200
Mailing Address - Fax:630-718-0900
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:ROOM 607
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5188
Practice Address - Country:US
Practice Address - Phone:773-296-3456
Practice Address - Fax:773-296-3622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620377OtherBLUE CROSS / BLUE SHIELD
IL381250Medicare ID - Type Unspecified