Provider Demographics
NPI:1114982154
Name:NAYAK, PERNANKEL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PERNANKEL
Middle Name:D
Last Name:NAYAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PERNANKEL
Other - Middle Name:DHARMADEV L
Other - Last Name:NAYAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:414 W VIRGINIA AVE
Mailing Address - Street 2:P O BOX 1169
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2258
Mailing Address - Country:US
Mailing Address - Phone:217-342-9738
Mailing Address - Fax:217-342-9806
Practice Address - Street 1:414 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2258
Practice Address - Country:US
Practice Address - Phone:217-342-9738
Practice Address - Fax:217-342-9806
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054866208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCC9824OtherRAILROAD MEDICARE
IL87362624OtherFIRST HEALTH
IL003058OtherHEALTHALLIANCE
IL036054866Medicaid
IL02500053OtherBCBS
IL207387OtherHEALTHLINK
IL622443OtherTRIGON BC
IL036054866Medicaid
IL87362624OtherFIRST HEALTH