Individual
PONNAMBALAM S SUNDRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
71 W 156TH ST, STE 305, HARVEY, IL 60426-4260
(708) 331-2200
(708) 331-8015
Mailing address
71 W 156TH ST, STE 305, HARVEY, IL 60426-4260
(708) 331-2200
(708) 331-8015
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036070565
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360705655
—
IL
01
—
060058942
PALMETTO RR MEDICARE
IL
Enumeration date
01/09/2006
Last updated
02/21/2011
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