Basic Information
| Provider Information | |||||||||
| NPI: | 1255520532 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERMA | ||||||||
| FirstName: | NEELAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 FOREST HILL | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626500000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302724380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 W WALNUT | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626500000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2172438455 | ||||||||
| FaxNumber: | 2172437951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2007 | ||||||||
| LastUpdateDate: | 09/19/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VX0000X | 4301089971 | MI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207VX0000X | 036133992 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics |
ID Information
| ID | Type | State | Issuer | Description | 036133992 | 05 | IL | MEDICAID |