Provider Demographics
NPI:1053517839
Name:UDANI, SUNEEL MAHENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SUNEEL
Middle Name:MAHENDRA
Last Name:UDANI
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 1:120 W 22ND ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1563
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-495-9356
Practice Address - Fax:630-495-9357
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118486207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
400280OtherGROUP MEDICARE PTAN
ILT01290Medicare PIN
ILT01291Medicare PIN
400280OtherGROUP MEDICARE PTAN