Basic Information
| Provider Information | |||||||||
| NPI: | 1265407829 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANI | ||||||||
| FirstName: | SUREKHA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6910 S MADISON ST | ||||||||
| Address2: | |||||||||
| City: | WILLIOWBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303212788 | ||||||||
| FaxNumber: | 6303231699 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 GOLF RD | ||||||||
| Address2: | SUITE 212 | ||||||||
| City: | DES PLAINES | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8472971800 | ||||||||
| FaxNumber: | 8472972757 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1615479 | 01 | BCBS | OTHER |