Individual
THEODORE R SUNDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
421 N 9TH ST, SPRINGFIELD, IL 62702-5317
(217) 757-6888
(217) 757-6869
Mailing address
421 N 9TH ST, SPRINGFIELD, IL 62702-5317
(217) 757-6888
(217) 757-6869
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
036-088538
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036088538
—
IL
Enumeration date
12/05/2005
Last updated
04/08/2016
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