MEDICARE: DR. SANDEEP CHUNDURI MD

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	207RH0003X	Hematology & Oncology Physician	36110541	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1275843476	OTHER	IL	GROUP NPI NUMBER

General Provider Information

NPI Number	:	1174740435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDEEP CHUNDURI MD

Provider Business Mailing Address
First Line	:	525 E CONGRESS PKWY STE 300
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6258
Country	:	US
Telephone Number	:	815-759-9260
Fax Number	:	815-459-7840

Provider Business Practice Location Address
First Line	:	525 E CONGRESS PKWY
Second Line	:	SUITE 300
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6245
Country	:	US
Telephone Number	:	815-759-9260
Fax Number	:	815-459-7460

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	12/16/2021

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