Healthcare Provider Details

I. General information

NPI: 1891378568
Provider Name (Legal Business Name): KADAMBARI JANGAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 E 81ST AVE
MERRILLVILLE IN
46410-5538
US

IV. Provider business mailing address

PO BOX 3877
JOLIET IL
60434-3877
US

V. Phone/Fax

Practice location:
  • Phone: 219-472-0379
  • Fax: 219-472-0491
Mailing address:
  • Phone: 815-714-7171
  • Fax: 815-435-5080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01099148A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number57.257104
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: