Provider Demographics
NPI:1568520237
Name:SURENDEA M GULATI MD SC
Entity Type:Organization
Organization Name:SURENDEA M GULATI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GULATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-741-3942
Mailing Address - Street 1:2121 ONEIDA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-741-3942
Mailing Address - Fax:815-741-9712
Practice Address - Street 1:2121 ONEIDA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-741-3942
Practice Address - Fax:815-741-9712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009900516OtherBCBS
IL0009900516OtherBCBS
IL412490Medicare ID - Type Unspecified