Provider Demographics
NPI:1740494590
Name:SAJJAN K NEMANI MD SC
Entity type:Organization
Organization Name:SAJJAN K NEMANI MD SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MINOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-533-8700
Mailing Address - Street 1:1054 M L KING DR STE 124
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3065
Mailing Address - Country:US
Mailing Address - Phone:618-533-8700
Mailing Address - Fax:618-533-8701
Practice Address - Street 1:1054 M L KING DR STE 124
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3065
Practice Address - Country:US
Practice Address - Phone:618-533-8700
Practice Address - Fax:618-533-8701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360785562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL06123524OtherBLUE CROSS
IL111163OtherHEALTHLINK
IL036078556Medicaid
IL051812OtherHEALTH ALLIANCE
IL111163OtherHEALTHLINK