Individual
AMIT SURAPANENI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
(773) 975-1600
Mailing address
836 W WELLINGTON AVE, CHICAGO, IL 60657-5147
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
85267
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2015
Last updated
08/18/2020
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