Provider Demographics
NPI:1669588489
Name:SOMPALLI, CHANDRASEKHAR (MD)
Entity type:Individual
Prefix:DR
First Name:CHANDRASEKHAR
Middle Name:
Last Name:SOMPALLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEKHAR
Other - Middle Name:
Other - Last Name:SOMPALLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1401 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1259
Mailing Address - Country:US
Mailing Address - Phone:773-229-1414
Mailing Address - Fax:773-904-9857
Practice Address - Street 1:1401 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1259
Practice Address - Country:US
Practice Address - Phone:773-229-1414
Practice Address - Fax:773-904-9857
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094752207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09015685OtherBCBS
IL036094752Medicaid
IL036094752Medicaid
IL779491007Medicare PIN