Healthcare Provider Details

I. General information

NPI: 1437031416
Provider Name (Legal Business Name): ILLINOIS MEDICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14489 JOHN HUMPHREY DR STE 100
ORLAND PARK IL
60462-6209
US

IV. Provider business mailing address

14489 JOHN HUMPHREY DR STE 100
ORLAND PARK IL
60462-6209
US

V. Phone/Fax

Practice location:
  • Phone: 708-906-0741
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SUNDAR SIVAPRAKASAM
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 708-906-0741