Provider Demographics
NPI:1154361566
Name:JANI, HARSHAL (PA)
Entity type:Individual
Prefix:
First Name:HARSHAL
Middle Name:
Last Name:JANI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S PRESTON ROAD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:CELINA
Mailing Address - State:TX
Mailing Address - Zip Code:75009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 S PRESTON ROAD
Practice Address - Street 2:SUITE #130
Practice Address - City:CELINA
Practice Address - State:TX
Practice Address - Zip Code:75009
Practice Address - Country:US
Practice Address - Phone:214-947-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10933363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL2613OtherMEDICARE GROUP PTAN
4622394OtherBCBS
ILIL2613048OtherMEDICARE INDIVIDUAL PTAN
P00217480Medicare PIN
515250Medicare PIN
ILIL2613048OtherMEDICARE INDIVIDUAL PTAN
K18050Medicare PIN
CD0278Medicare PIN
4622394OtherBCBS