Provider Demographics
NPI:1265624282
Name:GOGINENI, JYOTHI (MD)
Entity type:Individual
Prefix:DR
First Name:JYOTHI
Middle Name:
Last Name:GOGINENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10370 HALIGUS RD STE 117
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9582
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:847-702-7207
Practice Address - Street 1:10370 HALIGUS RD STE 117
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:847-702-7207
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-122492207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036122492OtherSTATE LICENSE