Healthcare Provider Details

I. General information

NPI: 1902062037
Provider Name (Legal Business Name): SUJIT V JANARDHAN M.D., PH. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 HARVESTER DR SUITE 110
BURR RIDGE IL
60527-7594
US

IV. Provider business mailing address

5841 S MARYLAND AVE
CHICAGO IL
60637-1447
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1150
  • Fax:
Mailing address:
  • Phone: 773-834-1474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.128310
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036.128310
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: