Healthcare Provider Details

I. General information

NPI: 1609035617
Provider Name (Legal Business Name): SUDHI P KURUP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 70 ANN & ROBERT H. LURIES CHILDREN'S HOSPITAL OF CHICAGO
CHICAGO IL
60611-2605
US

IV. Provider business mailing address

225 E CHICAGO AVE # 70
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6180
  • Fax: 312-227-9411
Mailing address:
  • Phone: 312-227-6180
  • Fax: 312-227-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01093657A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036129730
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician
License Number036129730
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: