Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125075797 | IL |
N | 208200000X | Surgeon | 280520 | MA |
N | 208600000X | Surgeon | 280520 | MA |
NPI | 1104387166 |
---|---|
Provider Name | Dr. Ronak H Jani |
First Address | Maywood, IL 60153-3328 |
Second Address | Maywood, IL 60153-3328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2019 |
Last Update Date | 01/06/2020 |