Healthcare Provider Details

I. General information

NPI: 1740228857
Provider Name (Legal Business Name): SAMIR D UNDEVIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SPALDING DR STE 111
NAPERVILLE IL
60540-6766
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-2273
  • Fax: 630-646-6071
Mailing address:
  • Phone: 847-570-2040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number036102127
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: