MEDICARE: SAMANTHA CHIRUNOMULA QUARLESS MD

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	207R00000X	Internal Medicine Physician	036.154949	IL
2	207RI0200X	Infectious Disease Physician	036.154949	IL
3	207RA0401X	Addiction Medicine (Internal Medicine) Physician	036.154949	IL

General Provider Information

NPI Number	:	1639524119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA CHIRUNOMULA QUARLESS MD

Provider Business Mailing Address
First Line	:	912 S WOOD ST RM 137
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-4300
Country	:	US
Telephone Number	:	312-996-2019
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1202
Country	:	US
Telephone Number	:	312-996-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2016
Last Update Date	:	01/22/2026

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