Provider Demographics
NPI:1811978752
Name:SONI, JAIDEV C (MD)
Entity type:Individual
Prefix:DR
First Name:JAIDEV
Middle Name:C
Last Name:SONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-0967
Mailing Address - Country:US
Mailing Address - Phone:708-532-6029
Mailing Address - Fax:708-468-4991
Practice Address - Street 1:806 N LOGAN AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3716
Practice Address - Country:US
Practice Address - Phone:217-431-4290
Practice Address - Fax:217-431-4013
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360561102085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056110Medicaid
110002655OtherRR MEDICARE