1942468145 NPI number — DR. JANANDANA KALADHINI JEGANMOHAN M.D.

Table of content: DR. JANANDANA KALADHINI JEGANMOHAN M.D. (NPI 1942468145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942468145 NPI number — DR. JANANDANA KALADHINI JEGANMOHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JEGANMOHAN
Provider First Name:
JANANDANA
Provider Middle Name:
KALADHINI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGUILAR
Provider Other First Name:
JANANDANA
Provider Other Middle Name:
KALADHINI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942468145
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1014 E PATTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62959-3757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-997-4856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27025 W EAMES ST UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANNAHON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60410-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-467-1988
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2008

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: 207Q00000X , with the licence number:  036120200 , 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)





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