Provider Demographics
NPI:1487679205
Name:HARYANI, VIJAY M (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:M
Last Name:HARYANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N WALL ST STE C100
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2942
Mailing Address - Country:US
Mailing Address - Phone:844-404-4787
Mailing Address - Fax:815-936-3243
Practice Address - Street 1:500 N WALL ST STE C100
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2942
Practice Address - Country:US
Practice Address - Phone:844-404-4787
Practice Address - Fax:815-936-3243
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072339207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072339Medicaid
ILK04250OtherMEDICARE GROUP PROVIDER #
IL4632011OtherBCBS
IL4632011OtherBCBS
IL036072339Medicaid