Healthcare Provider Details

I. General information

NPI: 1962427856
Provider Name (Legal Business Name): SOUTHERN ILLINOIS ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6805 STATE ROUTE 162 STE 201
MARYVILLE IL
62062-8530
US

IV. Provider business mailing address

6805 STATE ROUTE 162 STE 201
MARYVILLE IL
62062-8530
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-5019
  • Fax: 618-288-5059
Mailing address:
  • Phone: 618-288-5019
  • Fax: 618-288-5059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJAY NIGAM
Title or Position: PRESIDENT
Credential: MD
Phone: 618-288-5019