MEDICARE: DR. SANJAY SAXENA M.D.

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	208000000X	Pediatrics Physician	036098372	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174625867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY SAXENA M.D.

Provider Business Mailing Address
First Line	:	2811 HUBBARD DR
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-9096
Country	:	US
Telephone Number	:	309-664-2515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 MALONEY DR
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-3750
Country	:	US
Telephone Number	:	309-663-1011
Fax Number	:	309-665-0825

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	09/10/2023

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