Provider Demographics
NPI:1568642106
Name:SINHA S CHUNDURI M.DS.C
Entity Type:Organization
Organization Name:SINHA S CHUNDURI M.DS.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SINHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUNDURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-343-2235
Mailing Address - Street 1:675 W NORTH AVE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160
Mailing Address - Country:US
Mailing Address - Phone:708-343-2235
Mailing Address - Fax:708-343-2250
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 511
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160
Practice Address - Country:US
Practice Address - Phone:708-343-2235
Practice Address - Fax:708-343-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048105207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048105Medicaid