Provider Demographics
NPI:1710977640
Name:BANGARULINGAM, SUJAY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJAY
Middle Name:Y
Last Name:BANGARULINGAM
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 1:2088 OGDEN AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4385
Mailing Address - Country:US
Mailing Address - Phone:630-499-7500
Mailing Address - Fax:630-898-3970
Practice Address - Street 1:2088 OGDEN AVE STE 250
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-4385
Practice Address - Country:US
Practice Address - Phone:630-499-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90753207RP1001X
IL036114727207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47598OtherBLUE CROSS/BLUESHIELD
FL47598ZMedicare ID - Type Unspecified
FLH68916Medicare UPIN
ILIL3270070Medicare PIN
FL47598OtherBLUE CROSS/BLUESHIELD