Provider Demographics
NPI:1487675989
Name:P N SOMPALLI MD SC
Entity type:Organization
Organization Name:P N SOMPALLI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PENCHALLI
Authorized Official - Middle Name:N
Authorized Official - Last Name:SOMPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-430-2400
Mailing Address - Street 1:8700 W 95TH ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2700
Mailing Address - Country:US
Mailing Address - Phone:708-430-2400
Mailing Address - Fax:708-430-2417
Practice Address - Street 1:6084 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2747
Practice Address - Country:US
Practice Address - Phone:708-430-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty