Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 036-067930 | IL |
Y | 111NI0900X | Internist | 036-067930 | IL |
N | 207RA0401X | Internist - Addiction Medicine | 036067930 | IL |
N | 207RG0300X | Geriatric Medicine | 036067930 | IL |
NPI | 1255330361 |
---|---|
Provider Name | Dr. Dinesh K Jain |
First Address | Tinley Park, IL 60477-2268 |
Second Address | Tinley Park, IL 60477-1918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 29/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01628096 | BCBSIL GROUP # (01) | IL |
036067930 | (05) | IL |
D16755 | (02) | IL |