THEODORE R SUNDER (NPI# 1255315065) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255315065 |
| Entity Type | Individual |
| Full Name | THEODORE R SUNDER |
| Credential | M.D. |
| Practice Address |
421 N 9th St Springfield IL 62702-5317 |
| Practice Telephone | 2177576888 |
| Practice Fax Number | 2177576869 |
| Mailing Telephone | 2177576888 |
| Mailing Fax Number | 2177576869 |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2016-04-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0402X |
Psychiatry & Neurology Specialization: Neurology with Special Qualifications in Child Neurology |
036-088538 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036088538 | 05 |
| Street Address |
421 N 9TH ST |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-5317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003818733 | Jacob Manoj Kitchener | Psychiatry & Neurology | 421 N 9th St, Springfield, IL 62702 | 2005-08-12 |
| 1356904148 | Andrea Jones | Nurse Practitioner | 421 N 9th St, Springfield, IL 62702-5317 | 2019-04-17 |
| 1003298001 | Breck Jones | Neurological Surgery | 421 N 9th St, Springfield, IL 62702-5317 | 2015-06-25 |
| 1720468507 | Jessica A Gorsek | Nurse Practitioner | 421 N 9th St, Springfield, IL 62702-5317 | 2015-06-05 |
| 1750796603 | Alex Michael | Neurological Surgery | 421 N 9th St, Springfield, IL 62702-5317 | 2014-06-29 |
| 1710229109 | Jigar Prakashchandra Mankad | Psychiatry & Neurology | 421 N 9th St, Springfield, IL 62702-5317 | 2013-03-23 |
| 1699026922 | Ann M Sparks | Nurse Practitioner | 421 N 9th St, Suite 240, Springfield, IL 62702-5317 | 2012-09-26 |
| 1831485960 | Janki Kiran Lavingia | Psychiatry & Neurology | 421 N 9th St, Springfield, IL 62702-5317 | 2011-06-28 |
| 1205068962 | Patricia Jean Klos | Nurse Practitioner | 421 N 9th St, Ste 240, Springfield, IL 62702-5317 | 2009-08-13 |
| 1235310756 | Gordon Kt Chu | Neurological Surgery | 421 N 9th St, Springfield, IL 62702-5317 | 2007-11-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 2084N0402X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology with Special Qualifications in Child Neurology |
| A Child Neurologist specializes in neurology with special skills in diagnosis and treatment of neurologic disorders of the neonatal period, infancy, early childhood, and adolescence. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205810082 | Michael R Pranzatelli | Psychiatry & Neurology | Southern Illinois University Healthcare Administration, Springfield, IL 62794 | 2005-12-05 |
| 1619382645 | Dusit Adstamongkonkul | Psychiatry & Neurology | 1000 E Primrose St Ste 200, Springfield, MO 65807 | 2014-06-28 |
| 1700146792 | Adam J David | Psychiatry & Neurology | 50 Wason Avenue, Springfield, MA 01107-1274 | 2012-05-23 |
| 1619289311 | Jacqueline A. Hauer | Psychiatry & Neurology | 1965 S Fremont Ave, Suite 130, Springfield, MO 65804-2201 | 2010-07-10 |
| 1023246600 | Jeffrey Russell Frank | Psychiatry & Neurology | 1 Hayden Bridge Way, Springfield, OR 97477-9747 | 2009-06-23 |
| 1811105331 | James J Collins | Psychiatry & Neurology | 1965 S Fremont Ave Ste 130, Springfield, MO 65804-2252 | 2007-05-18 |
| 1366562159 | David C Dredge | Psychiatry & Neurology | 50 Wason Ave, 1st Fl, Springfield, MA 01107-1274 | 2007-03-29 |
| 1518058676 | Anthony H Jackson | Psychiatry & Neurology | 50 Wason Ave, 1st Floor, Springfield, MA 01107-1274 | 2006-09-27 |
| 1033200944 | Beth A. Rosen | Psychiatry & Neurology | 50 Wason Avenue, 1st Floor, Springfield, MA 01107-1274 | 2006-09-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700226206 | Aliesje Sorgeloos | Psychiatry & Neurology | 4220 W 95th St Ste 210, Oak Lawn, IL 60453 | 2013-06-28 |
| 1851558001 | Lubov Romantseva | Psychiatry & Neurology | 1725 W Harrison St Ste 718, Department of Pediatrics, Section of Child Neurology, Chicago, IL 60612-3863 | 2008-05-16 |
| 1154597029 | Children's Physician Group | Psychiatry & Neurology | 1473 Commerce Dr, Algonquin, IL 60102-5916 | 2008-05-01 |
| 1457484669 | Michelle Annette Melyn | Psychiatry & Neurology | 7777 West Lake St, River Forest, IL 60305 | 2007-03-14 |
| 1992856678 | Shakuntala Chhabria | Psychiatry & Neurology | 222s Greenleaf St 111, Gurnee, IL 60031-5705 | 2007-01-16 |
| 1053481929 | Rita Yadava M.d.s.c. | Psychiatry & Neurology | 1200 South York Rd, 4150, Elmhurst, IL 60126 | 2006-11-08 |
| 1356446306 | Leonard D Elkun Md Sc | Psychiatry & Neurology | 411 W Ontario St, Suite 402, Chicago, IL 60610-6945 | 2006-09-14 |
| 1023129145 | Leonard David Elkun | Psychiatry & Neurology | 411 W. Ontario St, Suite 402, Chicago, IL 60610-6945 | 2006-08-31 |
| 1184636805 | Shaku Chhabria Neurological Services Sc | Psychiatry & Neurology | 222 S Greenleaf St Ste 111, Gurnee, IL 60031-5705 | 2006-08-12 |
| 1811929003 | Charles Nash Swisher | Psychiatry & Neurology | 2515 N Clark Street, Suite, Chicago, IL 60614 | 2006-07-07 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.