Individual
SARODE K PUNDALEEKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2614 W JEFFERSON ST, JOLIET, IL 60435
(815) 725-1355
(815) 725-9857
Mailing address
2614 W JEFFERSON ST, JOLIET, IL 60435
(815) 725-1355
(815) 725-9857
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
036052030
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036052030
—
IL
01
—
830000578
MEDICARE RR
IL
01
—
L29320
MEDICARE INDIV ID# FOR GROUP 336140
IL
01
—
L98065
MEDICARE INDIV ID# FOR GROUP 205474
IL
Enumeration date
09/20/2005
Last updated
01/20/2012
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