Provider Demographics
NPI:1770018061
Name:CHINNI, SUSHMA (DO)
Entity type:Individual
Prefix:
First Name:SUSHMA
Middle Name:
Last Name:CHINNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12251 S 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1290
Mailing Address - Country:US
Mailing Address - Phone:708-923-3388
Mailing Address - Fax:708-923-5859
Practice Address - Street 1:12251 S 80TH AVE
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1290
Practice Address - Country:US
Practice Address - Phone:708-923-3388
Practice Address - Fax:708-923-5859
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006431A207R00000X, 207R00000X
IL036-150267207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine