Provider Demographics
NPI:1477664639
Name:SIGNATURE HEALTHCARE SOLUTIONS,SC
Entity type:Organization
Organization Name:SIGNATURE HEALTHCARE SOLUTIONS,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUJITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDARARAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-479-6522
Mailing Address - Street 1:47 W DIVISION ST STE 269
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2339
Mailing Address - Country:US
Mailing Address - Phone:708-479-6522
Mailing Address - Fax:708-479-6597
Practice Address - Street 1:47 W DIVISION ST STE 269
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2339
Practice Address - Country:US
Practice Address - Phone:708-479-6522
Practice Address - Fax:708-479-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101003Medicaid
IL036101003Medicaid
IL210595Medicare ID - Type UnspecifiedMEDICARE PROVIDER #