Provider Demographics
NPI:1578537973
Name:SANDERS, JAMES JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:SANDERS
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 1:2900 FOXFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-513-8275
Mailing Address - Fax:630-513-9208
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-513-8275
Practice Address - Fax:630-513-9208
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCA4748OtherMEDICARE RAIL ROAD PTAN (GROUP)
IL920540OtherMEDICARE PTAN (GROUP)
IL920540015OtherMEDICARE PTAN (INDIVIDUAL)
IL036113487Medicaid
ILP01157955OtherMEDICARE RAIL ROAD PTAN (INDIVIDUAL)
K20916Medicare ID - Type Unspecified
IL036113487Medicaid