Provider Demographics
NPI:1174740435
Name:CHUNDURI, SANDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:
Last Name:CHUNDURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E CONGRESS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6258
Mailing Address - Country:US
Mailing Address - Phone:815-759-9260
Mailing Address - Fax:815-459-7840
Practice Address - Street 1:525 E CONGRESS PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6245
Practice Address - Country:US
Practice Address - Phone:815-759-9260
Practice Address - Fax:815-459-7460
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36110541207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1275843476OtherGROUP NPI NUMBER