Provider Demographics
NPI:1588124960
Name:ARUNKUMAR, PONNI (MD)
Entity type:Individual
Prefix:DR
First Name:PONNI
Middle Name:
Last Name:ARUNKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3705
Mailing Address - Country:US
Mailing Address - Phone:312-666-0500
Mailing Address - Fax:312-997-3024
Practice Address - Street 1:2121 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3705
Practice Address - Country:US
Practice Address - Phone:312-666-0500
Practice Address - Fax:312-997-3024
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106166207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic PathologyGroup - Single Specialty