Provider Demographics
NPI:1821045089
Name:JAGASIA, MAYA (MD)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:JAGASIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:F
Other - Last Name:PARDASANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1909 QUAIL RUN CC CT
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5210
Mailing Address - Country:US
Mailing Address - Phone:309-451-3699
Mailing Address - Fax:904-805-1302
Practice Address - Street 1:1909 QUAIL RUN CC CT
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-5210
Practice Address - Country:US
Practice Address - Phone:309-451-3699
Practice Address - Fax:904-805-1302
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36053763207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360537633Medicaid
P00195135OtherRAILROAD MCR
ILC44863Medicare UPIN
IL0360537633Medicaid