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NPI Code Detail

MEDICARE: SUNDAR SIVAPRAKASAM MD

MEDICARE: SUNDAR SIVAPRAKASAM 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
1207RC0200XCritical Care Medicine (Internal Medicine) Physician036052320IL

General Provider Information

NPI Number : 1720063530
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUNDAR SIVAPRAKASAM MD
Provider Business Mailing Address
First Line : 1296 WOBURN DR
Second Line :
City : LEMONT
State : IL
Zip : 60439-8933
Country : US
Telephone Number : 773-884-7920
Fax Number :
Provider Business Practice Location Address
First Line : 2701 W 68TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60629-1813
Country : US
Telephone Number : 773-884-7920
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2005
Last Update Date : 04/21/2009

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Directions to “ SUNDAR SIVAPRAKASAM MD” Practice Location

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