MEDICARE: SURENDER KUMAR, MD, SC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02232086	OTHER	IL	BLUE CROSS / BLUE SHIELD

General Provider Information

NPI Number	:	1366417057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURENDER KUMAR, MD, SC

Provider Business Mailing Address
First Line	:	PO BOX 64568
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85082-4568
Country	:	US
Telephone Number	:	630-288-6200
Fax Number	:	855-781-4084

Provider Business Practice Location Address
First Line	:	6084 S ARCHER AVE
Second Line	:	SUITE 102
City	:	CHICAGO
State	:	IL
Zip	:	60638-2747
Country	:	US
Telephone Number	:	773-884-4280
Fax Number	:	630-953-2347

Authorized Official
Title or Position	:	PHYSICIAN / OWNER
Name	:	DR. SURENDER KUMAR
Credential	:	M.D.
Telephone Number	:	630-718-0200

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/29/2019

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