Provider Demographics
NPI:1982799979
Name:SUNDARARAJ, SUJITH (MD)
Entity Type:Individual
Prefix:
First Name:SUJITH
Middle Name:
Last Name:SUNDARARAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1949
Mailing Address - Country:US
Mailing Address - Phone:708-229-4960
Mailing Address - Fax:
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:312-505-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101003207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101003Medicaid
ILIL5686079OtherMEDICARE PTAN
IL036101003Medicaid