MEDICARE: DR. SANJAY MANDAVA 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	207R00000X	Internal Medicine Physician	125088498	IL

General Provider Information

NPI Number	:	1386579431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY MANDAVA MD

Provider Business Mailing Address
First Line	:	PO BOX 19636
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62794-9636
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-9730

Provider Business Practice Location Address
First Line	:	751 N RUTLEDGE ST RM 1100
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-4968
Country	:	US
Telephone Number	:	217-545-3134
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/20/2026

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Directions to “ DR. SANJAY MANDAVA MD” Practice Location

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