Healthcare Provider Details

I. General information

NPI: 1811978752
Provider Name (Legal Business Name): JAIDEV C SONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N LOGAN AVE
DANVILLE IL
61832-3716
US

IV. Provider business mailing address

PO BOX 967
TINLEY PARK IL
60477-0967
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-4290
  • Fax: 217-431-4013
Mailing address:
  • Phone: 708-532-6029
  • Fax: 708-468-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036056110
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: