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1306465893 NPI number — SARATH KUMAR JAGANATHAN JAISHANKAR MD

NPI Number: 1306465893
Health Care Provider/Practitioner: SARATH KUMAR JAGANATHAN JAISHANKAR MD

Information about “1306465893” NPI (SARATH KUMAR JAGANATHAN JAISHANKAR MD) exists in 1306465893 in HTML format HTML  |  1306465893 in plain Text format TXT  |  1306465893 in PDF (Portable Document Format) PDF  |  1306465893 in an XML format XML  formats.

NPI Number : 1306465893 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1306465893",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JAGANATHAN JAISHANKAR",
    "FirstName": "SARATH KUMAR",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "530 NE GLEN OAK AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61637-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "309-655-2000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "530 NE GLEN OAK AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEORIA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61637-3801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "309-655-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/14/2020",
    "LastUpdateDate": "07/09/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "01/10/2022",
    "NPIReactivationDate": "02/22/2022",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2084V0102X",
        "TaxonomyName": "Vascular Neurology Physician",
        "LicenseNumber": "036168632",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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