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NPI Code Detail

MEDICARE: DR. SANDESH KUCHIPUDI M.D.

MEDICARE: DR. SANDESH KUCHIPUDI M.D.
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
1207R00000XInternal Medicine Physician036111755IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821057324
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDESH KUCHIPUDI M.D.
Provider Business Mailing Address
First Line : PO BOX 27
Second Line :
City : BROOKFIELD
State : IL
Zip : 60513-0027
Country : US
Telephone Number : 708-387-0121
Fax Number : 773-825-2466
Provider Business Practice Location Address
First Line : 7411 LAKE ST STE 1120
Second Line :
City : RIVER FOREST
State : IL
Zip : 60305-1882
Country : US
Telephone Number : 708-387-0121
Fax Number : 773-825-2466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2006
Last Update Date : 12/10/2025

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