Provider Demographics
NPI:1649220542
Name:NEMANI, SAJJAN K (MD)
Entity type:Individual
Prefix:DR
First Name:SAJJAN
Middle Name:K
Last Name:NEMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 STATE ROUTE 162
Mailing Address - Street 2:BOX 215
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-391-6495
Mailing Address - Fax:
Practice Address - Street 1:6828 STATE ROUTE 162 STE 2
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8558
Practice Address - Country:US
Practice Address - Phone:618-288-5906
Practice Address - Fax:618-288-5914
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360785562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051812OtherHEALTH ALLIANCE
IL036078556Medicaid
IL06123524OtherBLUE CROSS BLUE SHIELD
IL111163OtherHEALTHLINK
ILCI3449OtherRAILROAD MEDICARE
ILCI3449OtherRAILROAD MEDICARE
ILE19163Medicare UPIN