Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036.118486 | IL |
N | 111NI0900X | Internist | 036.118486 | IL |
Y | 207RN0300X | Nephrologist | 036118486 | IL |
NPI | 1053517839 |
---|---|
Provider Name | Dr. Suneel Mahendra Udani |
First Address | Hinsdale, IL 60521-3640 |
Second Address | Hinsdale, IL 60521-3634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
400280 | GROUP MEDICARE PTAN (01) |