Provider Demographics
NPI:1962449439
Name:NARUMANCHI, SUMAN (MD)
Entity Type:Individual
Prefix:
First Name:SUMAN
Middle Name:
Last Name:NARUMANCHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 JORIE BLVD
Mailing Address - Street 2:SUITE 186
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2213
Mailing Address - Country:US
Mailing Address - Phone:630-954-6700
Mailing Address - Fax:630-954-1555
Practice Address - Street 1:900 JORIE BLVD
Practice Address - Street 2:SUITE 186
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2213
Practice Address - Country:US
Practice Address - Phone:630-954-6700
Practice Address - Fax:630-954-1555
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-107271Medicaid
ILK33743OtherMEDICARE PIN FOR 645650
ILK33743OtherMEDICARE PIN FOR 645650
ILK28171Medicare PIN