Individual
MR. GAUTAM JHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1325 W. WHITTAKER, SUITE D, SALEM, IL 62881
(618) 740-0300
(618) 740-0301
Mailing address
1325 W. WHITTAKER, SUITE D, SALEM, IL 62881
(618) 740-0300
(618) 740-0301
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036096423
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036096423
—
IL
Enumeration date
12/20/2006
Last updated
10/11/2024
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