Healthcare Provider Details

I. General information

NPI: 1023800943
Provider Name (Legal Business Name): GUHAN ARUMUGAM SHANMUGASUNDARAM M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 SOUTH WOOD STREET ROOM 402, CLINICAL SCIENCES BUILDING, MAIL CODE 958
CHICAGO IL
60612
US

IV. Provider business mailing address

840 SOUTH WOOD STREET ROOM 402, CLINICAL SCIENCES BUILDING, MAIL CODE 958
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-355-0104
  • Fax: 312-413-3483
Mailing address:
  • Phone: 312-355-0104
  • Fax: 312-413-3483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125086481
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: