Basic Information
| Provider Information | |||||||||
| NPI: | 1740494590 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAJJAN K NEMANI MD SC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCE SLEEP & NEURODIAGNOSTIC SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1054 M L KING DR STE 124 | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628013065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185338700 | ||||||||
| FaxNumber: | 6185338701 | ||||||||
| Practice Location | |||||||||
| Address1: | 1054 M L KING DR STE 124 | ||||||||
| Address2: | |||||||||
| City: | CENTRALIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 628013065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185338700 | ||||||||
| FaxNumber: | 6185338701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MINOR | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
| AuthorizedOfficialMiddleName: | RENE | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6185338700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 036078556 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 06123524 | 01 | IL | BLUE CROSS | OTHER | 111163 | 01 | IL | HEALTHLINK | OTHER | 036078556 | 05 | IL | MEDICAID | 051812 | 01 | IL | HEALTH ALLIANCE | OTHER |