1114982154 NPI number — DR. PERNANKEL D NAYAK M.D.

Table of content: DR. PERNANKEL D NAYAK M.D. (NPI 1114982154)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114982154 NPI number — DR. PERNANKEL D NAYAK M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NAYAK
Provider First Name:
PERNANKEL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NAYAK
Provider Other First Name:
PERNANKEL
Provider Other Middle Name:
DHARMADEV L.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114982154
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 W VIRGINIA AVE
Provider Second Line Business Mailing Address:
P O BOX 1169
Provider Business Mailing Address City Name:
EFFINGHAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62401-2258
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-342-9738
Provider Business Mailing Address Fax Number:
217-342-9806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 W VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401-2258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-342-9738
Provider Business Practice Location Address Fax Number:
217-342-9806
Provider Enumeration Date:
04/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208800000X , with the licence number:  036054866 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CC9824 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 87362624 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 003058 . This is a "HEALTHALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036054866 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02500053 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 207387 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 622443 . This is a "TRIGON BC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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