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General NPI Number Information
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NPI Number | 1942468145
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Entity Type | Individual
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Provider Name | JANANDANA KALADHINI JEGANMOHAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2008
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 27025 W EAMES ST UNIT B
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City | CHANNAHON
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State | IL
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Zip | 60410-5620
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Country | US
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Telephone | 815-467-1988
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 E PATTON DR
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City | MARION
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State | IL
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Zip | 62959-3757
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Country | US
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Telephone | 618-997-4856
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036120200
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License Number State | IL
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