Provider Demographics
NPI:1699777052
Name:VINODKUMAR, SUNDER (MD)
Entity type:Individual
Prefix:
First Name:SUNDER
Middle Name:
Last Name:VINODKUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LAVERGNE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2024
Mailing Address - Country:US
Mailing Address - Phone:847-594-1805
Mailing Address - Fax:
Practice Address - Street 1:500 LAVERGNE AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2024
Practice Address - Country:US
Practice Address - Phone:847-594-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070921207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036070921Medicaid
IL0031601740OtherBC-BS
ILP00074706OtherRAILROAD
IL0031601740OtherBC-BS
IL036070921Medicaid