MEDICARE: PIROJNA JANTRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	36053161	IL

General Provider Information

NPI Number	:	1043277841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIROJNA JANTRA MD

Provider Business Mailing Address
First Line	:	2825 GLENWOOD AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61101-3542
Country	:	US
Telephone Number	:	815-965-9712
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 GLENWOOD AVE
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61101-3542
Country	:	US
Telephone Number	:	815-965-9712
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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