NPIMap

Organization Active NPI

Balkrishna Sundar MD SC

  • Urology Physician
  • Chicago, IL
National Provider Identifier
1316049166
Registry record updated Oct 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036053086 Issued in IL
Legal business name
BALKRISHNA SUNDAR MD SC
Doing business as
Lakeshore Urology
Practice address
2674 N Halsted St
Chicago, IL 60614-2361
Phone
(773) 868-1800
Fax
(773) 868-4072
NPI assigned
Sep 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Balakrishna Sundar, M.D.
Title
President
Phone
(847) 692-6218

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X 036053086 IL Primary

Addresses

Primary practice location

2674 N Halsted St
Chicago, IL 60614-2361

Mailing address

PO Box 798
Park Ridge, IL 60068
Phone (847) 692-6218

Other identifiers 4

IdentifierTypeStateIssuer
036053086MedicaidIL
791342246OtherPALMETTO GBA
21609137OtherBC/BS
DH1341OtherPALMETTO GBA

Other names 1

  • Lakeshore Urology Doing business as

National Provider Directory

National Provider Directory

Locations

2400 N Ashland Ave
Fl 2
Chicago, IL 60614
Phone (773) 868-1800

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224720000000",
    "number": "1316049166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 798",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "60068",
            "telephone_number": "847-692-6218",
            "fax_number": "847-692-5609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2674 N HALSTED ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606142361",
            "telephone_number": "773-868-1800",
            "fax_number": "773-868-4072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALKRISHNA SUNDAR MD SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-02",
        "last_updated": "2008-10-23",
        "status": "A",
        "authorized_official_last_name": "SUNDAR",
        "authorized_official_first_name": "BALAKRISHNA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-692-6218",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "IL",
            "license": "036053086",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036053086",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "791342246",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "21609137",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "DH1341",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeshore Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.