Provider Demographics
NPI:1942278973
Name:NIGAM, SANJAY K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:K
Last Name:NIGAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6805 STATE ROUTE 162 STE 201
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8530
Mailing Address - Country:US
Mailing Address - Phone:618-288-5019
Mailing Address - Fax:618-288-5059
Practice Address - Street 1:6805 STATE ROUTE 162
Practice Address - Street 2:STE 201
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8530
Practice Address - Country:US
Practice Address - Phone:618-288-5019
Practice Address - Fax:618-288-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361070242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry