Provider Demographics
NPI:1922396399
Name:ANJULI S. NAYAK, M.D.
Entity Type:Organization
Organization Name:ANJULI S. NAYAK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:RANDE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-452-0995
Mailing Address - Street 1:2010 JACOBSSEN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6280
Mailing Address - Country:US
Mailing Address - Phone:309-452-0995
Mailing Address - Fax:309-862-0961
Practice Address - Street 1:2010 JACOBSSEN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-6280
Practice Address - Country:US
Practice Address - Phone:309-452-0995
Practice Address - Fax:309-862-0961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty