Healthcare Provider Details

I. General information

NPI: 1316568116
Provider Name (Legal Business Name): POOJA VISHAL NANGRANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REKHA BAI MD

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NE GLEN OAK AVE
PEORIA IL
61637-0001
US

IV. Provider business mailing address

1590 MAPLE HEIGHTS DR
DELAWARE OH
43015-4594
US

V. Phone/Fax

Practice location:
  • Phone: 309-624-8818
  • Fax: 309-624-8820
Mailing address:
  • Phone: 817-412-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036178518
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.152209
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: