MEDICARE: BALAKRISHNA SUNDAR 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	208800000X	Urology Physician	036053086	IL
2	208800000X	Urology Physician	C153404	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	21609137	OTHER		BLUE SHIELD
3	036053086	OTHER	IL	STATE LICENSE
4	791342246	OTHER		PALMETTO GBA

General Provider Information

NPI Number	:	1841217551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BALAKRISHNA SUNDAR MD

Provider Business Mailing Address
First Line	:	500 N LINCOLN AVE
Second Line	:
City	:	PARK RIDGE
State	:	IL
Zip	:	60068-3141
Country	:	US
Telephone Number	:	847-692-6218
Fax Number	:	847-692-5609

Provider Business Practice Location Address
First Line	:	2450 ORO DAM BLVD E
Second Line	:
City	:	OROVILLE
State	:	CA
Zip	:	95966-6052
Country	:	US
Telephone Number	:	530-712-2171
Fax Number	:	530-712-2149

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/09/2023

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Directions to “ BALAKRISHNA SUNDAR MD” Practice Location

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