Provider Demographics
NPI:1952588642
Name:S B JANI MD PC
Entity type:Organization
Organization Name:S B JANI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDDHARTH
Authorized Official - Middle Name:B
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-263-6575
Mailing Address - Street 1:1106 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-2444
Mailing Address - Country:US
Mailing Address - Phone:618-263-6575
Mailing Address - Fax:618-262-4468
Practice Address - Street 1:1106 OAK ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-2444
Practice Address - Country:US
Practice Address - Phone:618-263-6575
Practice Address - Fax:618-262-4468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216233Medicare PIN
IL148970Medicare Oscar/Certification