Healthcare Provider Details

I. General information

NPI: 1285830935
Provider Name (Legal Business Name): ARCHANA R NARAYAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N HAMMES AVE
JOLIET IL
60435-8100
US

IV. Provider business mailing address

229 N HAMMES AVE
JOLIET IL
60435-8100
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-2300
  • Fax: 815-744-9208
Mailing address:
  • Phone: 815-744-2300
  • Fax: 815-744-9208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number036118762
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: