Provider Demographics
NPI:1780965582
Name:TULADHAR, SAMPURNA MAN (MD)
Entity type:Individual
Prefix:DR
First Name:SAMPURNA
Middle Name:MAN
Last Name:TULADHAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:710 OAKTON ST
Mailing Address - Street 2:APARTMENT 402
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2927
Mailing Address - Country:US
Mailing Address - Phone:571-409-9326
Mailing Address - Fax:
Practice Address - Street 1:5841 S MARYLAND AVENUE
Practice Address - Street 2:M/C 1052
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1470
Practice Address - Country:US
Practice Address - Phone:773-702-6760
Practice Address - Fax:773-702-0861
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
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Provider Licenses
StateLicense IDTaxonomies
IL125059671208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)