Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036061831 | IL |
NPI | 1003924796 |
---|---|
Provider Name | Madhu B Jain |
First Address | Woodridge, IL 60517-3100 |
Second Address | Woodridge, IL 60517-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 24/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036061831 | (02) | |
C44269 | (02) |