Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 5101022846 | MI |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 036152212 | IL |
NPI | 1184071896 |
---|---|
Provider Name | Dr. Sudheer Earanky |
First Address | Chicago, IL 60622-2932 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2016 |
Last Update Date | 10/02/2022 |