Healthcare Provider Details

I. General information

NPI: 1083659171
Provider Name (Legal Business Name): JATOI CLINIC, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 04/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E LAKE SHORE DR SUITE 100
DECATUR IL
62521-3809
US

IV. Provider business mailing address

1750 E LAKE SHORE DR SUITE 100
DECATUR IL
62521-3809
US

V. Phone/Fax

Practice location:
  • Phone: 217-464-2505
  • Fax: 217-464-3144
Mailing address:
  • Phone: 217-464-2505
  • Fax: 217-464-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name: DR. NAEEMUDDIN JATOI
Title or Position: OWNER
Credential: M.D.
Phone: 217-464-2505