Healthcare Provider Details

I. General information

NPI: 1821057324
Provider Name (Legal Business Name): SANDESH KUCHIPUDI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7411 LAKE ST STE 1120
RIVER FOREST IL
60305-1882
US

IV. Provider business mailing address

PO BOX 27
BROOKFIELD IL
60513-0027
US

V. Phone/Fax

Practice location:
  • Phone: 708-387-0121
  • Fax: 773-825-2466
Mailing address:
  • Phone: 708-387-0121
  • Fax: 773-825-2466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036111755
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: