Healthcare Provider Details

I. General information

NPI: 1154690626
Provider Name (Legal Business Name): SUMEET G DUA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W CONGRESS PKWY
CHICAGO IL
60612-3833
US

IV. Provider business mailing address

1443 W FILLMORE ST UNIT B
CHICAGO IL
60607-4615
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5779
  • Fax:
Mailing address:
  • Phone: 312-694-5534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number036135106
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036135106
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036135106
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: