Individual
BALAKRISHNA SUNDAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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