Provider Demographics
NPI:1306880455
Name:NAIR, INDIRA DEVI (MD, SC)
Entity type:Individual
Prefix:DR
First Name:INDIRA
Middle Name:DEVI
Last Name:NAIR
Suffix:
Gender:F
Credentials:MD, SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8565 W DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1406
Mailing Address - Country:US
Mailing Address - Phone:847-873-9367
Mailing Address - Fax:847-518-9395
Practice Address - Street 1:8565 W DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1472
Practice Address - Country:US
Practice Address - Phone:847-873-9367
Practice Address - Fax:224-246-8127
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC7379Medicare UPIN
IL657970Medicare ID - Type Unspecified