Provider Demographics
NPI:1013099225
Name:VIJAY M. HARYANI, MD, SC
Entity Type:Organization
Organization Name:VIJAY M. HARYANI, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-936-3240
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-936-3240
Mailing Address - Fax:815-936-3243
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:SUITE 310
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-936-3240
Practice Address - Fax:815-936-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072339207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4632011OtherBCBS GROUP
IL4632011OtherBCBS GROUP