Provider Demographics
NPI:1205089562
Name:JOLIET DIABETES & ENDOCRINOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:JOLIET DIABETES & ENDOCRINOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAVANI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIVARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-744-1089
Mailing Address - Street 1:1715 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5835
Mailing Address - Country:US
Mailing Address - Phone:815-744-1089
Mailing Address - Fax:815-744-0460
Practice Address - Street 1:1715 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5835
Practice Address - Country:US
Practice Address - Phone:815-744-1089
Practice Address - Fax:815-744-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072478174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty