Provider Demographics
NPI:1871632018
Name:JEJURIKAR, SANDEEP S (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:S
Last Name:JEJURIKAR
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 1:3800 HIGHLAND AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1558
Mailing Address - Country:US
Mailing Address - Phone:630-960-0023
Mailing Address - Fax:630-960-4137
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:601
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1090
Practice Address - Country:US
Practice Address - Phone:847-755-1000
Practice Address - Fax:847-843-7793
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL59775Medicare UPIN
IL726580Medicare ID - Type UnspecifiedSANDEEP S JEJURIKAR