Provider Demographics
NPI:1255366761
Name:NILAVAR, SUNDAR VASUDEVARAO (MD)
Entity type:Individual
Prefix:DR
First Name:SUNDAR
Middle Name:VASUDEVARAO
Last Name:NILAVAR
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 1:96 LOOKOUT CT
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9414
Mailing Address - Country:US
Mailing Address - Phone:937-652-7882
Mailing Address - Fax:
Practice Address - Street 1:96 LOOKOUT CT
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9414
Practice Address - Country:US
Practice Address - Phone:937-652-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0395552085R0202X
MI43010335962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE38767Medicare UPIN