Provider Demographics
NPI:1659517571
Name:JAYANTI PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAYANTI PROFESSIONAL CORPORATION
Other - Org Name:INSTITUTE OF INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JAYANTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-854-7444
Mailing Address - Street 1:2654 SW 32ND PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-7847
Mailing Address - Country:US
Mailing Address - Phone:352-854-7444
Mailing Address - Fax:352-873-6647
Practice Address - Street 1:2654 SW 32ND PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7847
Practice Address - Country:US
Practice Address - Phone:352-854-7444
Practice Address - Fax:352-671-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5701051OtherNCPDP PROVIDER IDENTIFICATION NUMBER