Organization
BALKRISHNA SUNDAR MD SC
Active
Other names
Lakeshore Urology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BALAKRISHNA SUNDAR M.D. (PRESIDENT)
(847) 692-6218
Entity
Organization
Contact information
Practice address
2674 N HALSTED ST, CHICAGO, IL 60614-2361
(773) 868-1800
(773) 868-4072
Mailing address
PO BOX 798, PARK RIDGE, IL 60068
(847) 692-6218
(847) 692-5609
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
036053086
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053086
—
IL
01
—
21609137
BC/BS
—
01
—
791342246
PALMETTO GBA
—
01
—
DH1341
PALMETTO GBA
—
Enumeration date
09/02/2006
Last updated
10/23/2008
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