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General NPI Number Information
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NPI Number | 1174740435
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Entity Type | Individual
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Provider Name | SANDEEP CHUNDURI MD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 525 E CONGRESS PKWY SUITE 300
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6245
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Country | US
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Telephone | 815-759-9260
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Fax | 815-459-7460
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Provider Business Mailing Address
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Address Line | 525 E CONGRESS PKWY STE 300
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6258
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Country | US
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Telephone | 815-759-9260
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Fax | 815-459-7840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 36110541
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License Number State | IL
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