Provider Demographics
NPI:1649240276
Name:JANDALI, ASAAD (MD)
Entity Type:Individual
Prefix:MR
First Name:ASAAD
Middle Name:
Last Name:JANDALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ASAAD
Other - Middle Name:
Other - Last Name:ALJANDALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1103
Mailing Address - Country:US
Mailing Address - Phone:219-662-3931
Mailing Address - Fax:219-663-6359
Practice Address - Street 1:8840 CALUMET AVE STE 203
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2546
Practice Address - Country:US
Practice Address - Phone:219-836-7723
Practice Address - Fax:219-836-7726
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045439A207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1500622OtherCIGNA
IN200164170Medicaid
IN000000338444OtherANTHEM
IL036093513OtherMEDICAID IL
IL90001173OtherBLUE CROSS BLUE SHIELD
INP00141901OtherMEDICARE RAILROAD
IN200164170Medicaid
IN000000338444OtherANTHEM