MEDICARE: SUMVRUDHI LOKESH CHARIYAMANE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1013719509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMVRUDHI LOKESH CHARIYAMANE

Provider Business Mailing Address
First Line	:	1 CARDINAL WAY APT 2509
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63102-2818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5640
Country	:	US
Telephone Number	:	773-665-6730
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2025
Last Update Date	:	04/07/2026

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