Basic Information
| Provider Information | |||||||||
| NPI: | 1740454305 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOKFI | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JANKA | ||||||||
| OtherFirstName: | JACQUELINE | ||||||||
| OtherMiddleName: | J. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5215 HOLY CROSS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | MISHAWAKA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743355000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5215 HOLY CROSS PARKWAY | ||||||||
| Address2: | |||||||||
| City: | MISHAWAKA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 46545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5743355000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 041838 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 041838 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RI0200X | 041838 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 01072102A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 01072102A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.