Healthcare Provider Details

I. General information

NPI: 1447314737
Provider Name (Legal Business Name): GAUTAM JHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S 4TH ST STE 30
EFFINGHAM IL
62401-4162
US

IV. Provider business mailing address

1901 S 4TH ST STE 30
EFFINGHAM IL
62401-4162
US

V. Phone/Fax

Practice location:
  • Phone: 877-275-3754
  • Fax:
Mailing address:
  • Phone: 877-275-3754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036096423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: