Provider Demographics
NPI:1194812602
Name:SINGH, JITINDER (DO)
Entity type:Individual
Prefix:
First Name:JITINDER
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9508
Mailing Address - Country:US
Mailing Address - Phone:815-463-3700
Mailing Address - Fax:815-463-3701
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:SUITE 570
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9508
Practice Address - Country:US
Practice Address - Phone:815-463-3700
Practice Address - Fax:815-463-3701
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2015-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036089209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089209Medicaid
IL036089209Medicaid
ILIL1654002Medicare Oscar/Certification