Provider Demographics
NPI:1437031416
Name:ILLINOIS MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:ILLINOIS MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVAPRAKASAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-906-0741
Mailing Address - Street 1:14489 JOHN HUMPHREY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-6209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14489 JOHN HUMPHREY DR STE 100
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-6209
Practice Address - Country:US
Practice Address - Phone:708-906-0741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty