Healthcare Provider Details

I. General information

NPI: 1295771103
Provider Name (Legal Business Name): SUGNI SUKHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 GLENWOOD AVE
JOLIET IL
60435-5487
US

IV. Provider business mailing address

2100 GLENWOOD AVE
JOLIET IL
60435-5487
US

V. Phone/Fax

Practice location:
  • Phone: 815-725-2121
  • Fax: 815-741-6303
Mailing address:
  • Phone: 815-725-2121
  • Fax: 815-741-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36-062425
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: