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NPI Code Detail

MEDICARE: DR. JENNIFER C MANEJA MD

MEDICARE: DR. JENNIFER C MANEJA 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
1207RG0300XGeriatric Medicine (Internal Medicine) Physician036115729IL

General Provider Information

NPI Number : 1194775064
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JENNIFER C MANEJA MD
Provider Business Mailing Address
First Line : 1025 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2403
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 300 N MAPLE ST
Second Line :
City : EFFINGHAM
State : IL
Zip : 62401-2003
Country : US
Telephone Number : 217-342-4151
Fax Number : 217-347-8955
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 05/21/2020

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