Individual
MRS. HAMSAVENI K JAGANNATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
311 EAST MAIN STREET, SUITE 409, GALESBURG, IL 61401
(309) 343-6162
(309) 343-3802
Mailing address
1958CORNELIA ROAD, GALESBURG, IL 61401
(309) 343-3585
(309) 343-7313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371011627001
—
IL
Enumeration date
09/28/2006
Last updated
07/08/2007
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