Individual
BALAKRISHNA SUNDAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2450 ORO DAM BLVD E, OROVILLE, CA 95966-6052
(530) 712-2171
(530) 712-2149
Mailing address
500 N LINCOLN AVE, PARK RIDGE, IL 60068-3141
(847) 692-6218
(847) 692-5609
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
036053086
IL
208800000X
Urology Physician
Primary
C153404
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036053086
STATE LICENSE
IL
05
—
036053086
—
IL
01
—
21609137
BLUE SHIELD
—
01
—
791342246
PALMETTO GBA
—
Enumeration date
07/17/2006
Last updated
05/09/2023
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