Provider Demographics
NPI:1649220542
Name:NEMANI, SAJJAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJJAN
Middle Name:K
Last Name:NEMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4225 LINCOLNSHIRE DR STE B
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2157
Mailing Address - Country:US
Mailing Address - Phone:618-242-2317
Mailing Address - Fax:618-242-9710
Practice Address - Street 1:1054 MARTIN LUTHER KING
Practice Address - Street 2:SUITE 124
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-533-8700
Practice Address - Fax:618-533-8701
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360785562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL111163OtherHEALTHLINK
IL036078556Medicaid
IL06123524OtherBLUE CROSS BLUE SHIELD
IL051812OtherHEALTH ALLIANCE
ILCI3449OtherRAILROAD MEDICARE
ILCI3449OtherRAILROAD MEDICARE
ILE19163Medicare UPIN