Provider Demographics
NPI:1225087489
Name:DEGANI, JOYAL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOYAL
Middle Name:
Last Name:DEGANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOYAL
Other - Middle Name:
Other - Last Name:DEGANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:520 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1022
Mailing Address - Country:US
Mailing Address - Phone:312-404-4657
Mailing Address - Fax:
Practice Address - Street 1:520 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1022
Practice Address - Country:US
Practice Address - Phone:312-404-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047470A174400000X
IL036089149207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL399980OtherGROUP MEDICARE PTAN
CN4921OtherRRMC