Provider Demographics
NPI:1518535566
Name:JHA, PANAV ARJUN (MD)
Entity Type:Individual
Prefix:MR
First Name:PANAV
Middle Name:ARJUN
Last Name:JHA
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 1:7702 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-3107
Mailing Address - Country:US
Mailing Address - Phone:815-971-3397
Mailing Address - Fax:815-971-9795
Practice Address - Street 1:78 7702 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111
Practice Address - Country:US
Practice Address - Phone:815-971-3397
Practice Address - Fax:815-971-9795
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2023-05-30
Deactivation Date:2023-04-06
Deactivation Code:
Reactivation Date:2023-05-24
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125.078986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program