Basic Information
| Provider Information | |||||||||
| NPI: | 1649220542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEMANI | ||||||||
| FirstName: | SAJJAN | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4225 LINCOLNSHIRE DR STE B | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628642157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182422317 | ||||||||
| FaxNumber: | 6182429710 | ||||||||
| Practice Location | |||||||||
| Address1: | 1054 MARTIN LUTHER KING | ||||||||
| Address2: | SUITE 124 | ||||||||
| City: | CENTRALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185338700 | ||||||||
| FaxNumber: | 6185338701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 036078556 | IL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 051812 | 01 | IL | HEALTH ALLIANCE | OTHER | CI3449 | 01 | IL | RAILROAD MEDICARE | OTHER | 06123524 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 036078556 | 05 | IL | MEDICAID | 111163 | 01 | IL | HEALTHLINK | OTHER |