Provider Demographics
NPI:1356780530
Name:ELITE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Entity type:Organization
Organization Name:ELITE ORTHOPAEDICS AND SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRASEKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-229-1414
Mailing Address - Street 1:6524 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2400
Mailing Address - Country:US
Mailing Address - Phone:773-229-1414
Mailing Address - Fax:
Practice Address - Street 1:2875 W 19TH ST
Practice Address - Street 2:2ND FLOOR - PHYSICIAN CENTER (NORTH SUITE)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3501
Practice Address - Country:US
Practice Address - Phone:773-229-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094752207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty