Provider Demographics
NPI:1881877140
Name:SUNT WANA MDSC
Entity type:Organization
Organization Name:SUNT WANA MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNT
Authorized Official - Middle Name:
Authorized Official - Last Name:WANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-655-0024
Mailing Address - Street 1:160 RODGERS CT
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5426
Mailing Address - Country:US
Mailing Address - Phone:630-655-0024
Mailing Address - Fax:
Practice Address - Street 1:8046 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-4004
Practice Address - Country:US
Practice Address - Phone:773-723-2300
Practice Address - Fax:773-723-2301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211973Medicare PIN