Provider Demographics
NPI:1760684377
Name:CHUNDURI, KRISHNA C (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISHNA
Middle Name:C
Last Name:CHUNDURI
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 1:15W302 60TH ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5201
Mailing Address - Country:US
Mailing Address - Phone:312-952-2226
Mailing Address - Fax:
Practice Address - Street 1:6524 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2400
Practice Address - Country:US
Practice Address - Phone:773-717-0890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118198207L00000X
IL036118798207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01638884OtherBLUE CROSS BLUE SHIELD
IL036118798Medicaid
IL036118798Medicaid