MEDICARE: P N SOMPALLI MD SC

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	174400000X	Specialist		IL

General Provider Information

NPI Number	:	1487675989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P N SOMPALLI MD SC

Provider Business Mailing Address
First Line	:	8700 W 95TH ST
Second Line	:	SUITE 6
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-2700
Country	:	US
Telephone Number	:	708-430-2400
Fax Number	:	708-430-2417

Provider Business Practice Location Address
First Line	:	6084 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-2747
Country	:	US
Telephone Number	:	708-430-2400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PENCHALLI N SOMPALLI
Credential	:	M.D.
Telephone Number	:	708-430-2400

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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Directions to “P N SOMPALLI MD SC ” Practice Location

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