Basic Information
| Provider Information | |||||||||
| NPI: | 1689698359 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHERALA | ||||||||
| FirstName: | SUNDARARAJ | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 WEXFORD CT | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601755655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305848391 | ||||||||
| FaxNumber: | 6305249018 | ||||||||
| Practice Location | |||||||||
| Address1: | 1710 N RANDALL RD | ||||||||
| Address2: | # 370 | ||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601239400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478884432 | ||||||||
| FaxNumber: | 8478884436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 05/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | 036077595 | IL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04532058 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER |