Puangpeth - Jantra, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Practice address

820 S Damen Ave
Chicago, IL 60612-3728

Phone

(312) 569-6380

Fax

(312) 569-8050

NPI assigned

Jun 10, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285675058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 YORKSHIRE LN",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622917",
            "telephone_number": "847-480-9069",
            "fax_number": "312-569-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S DAMEN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123728",
            "telephone_number": "312-569-6380",
            "fax_number": "312-569-8050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANTRA",
        "first_name": "PUANGPETH",
        "middle_name": "-",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynne K Jansky, CNS APN
• Nicole Jansma, M.S., BCBA
• Stephanie Jolyn Jansma
• Aron Janssen, M.D.
• Beata Janton
• Lori Lynn Janu-Chossek, LCSW
• Alicia M January, PH.D.
• Mary Theresa Janus, OTR/L
• Nicole Jeannette Janus, FNP-BC, CPNP-AC
• Paulette Janus, LSCW

• Physical Medicine & Rehabilitation Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Medicine & Rehabilitation Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.