Healthcare Provider Details

I. General information

NPI: 1104045160
Provider Name (Legal Business Name): RADHA SUKHANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RADHA SUKHANI M.D.

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E ERIE ST
CHICAGO IL
60611-2740
US

IV. Provider business mailing address

225 N COLUMBUS DR UNIT 6005
CHICAGO IL
60601-7910
US

V. Phone/Fax

Practice location:
  • Phone: 312-649-3939
  • Fax: 312-649-5747
Mailing address:
  • Phone: 630-853-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036064349
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: