Provider Demographics
NPI:1265407829
Name:JANI, SUREKHA P (MD)
Entity type:Individual
Prefix:
First Name:SUREKHA
Middle Name:P
Last Name:JANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WILLIOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-321-2788
Mailing Address - Fax:630-323-1699
Practice Address - Street 1:1455 GOLF RD
Practice Address - Street 2:SUITE 212
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-297-1800
Practice Address - Fax:847-297-2757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1615479OtherBCBS
920170Medicare ID - Type Unspecified
1615479OtherBCBS
D14936Medicare UPIN