Provider Demographics
NPI:1588776611
Name:JAIN, BHAGWAN D (MD)
Entity type:Individual
Prefix:DR
First Name:BHAGWAN
Middle Name:D
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6401 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5414
Mailing Address - Country:US
Mailing Address - Phone:630-226-0846
Mailing Address - Fax:630-679-0052
Practice Address - Street 1:840 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-975-6773
Practice Address - Fax:773-935-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD14028Medicare UPIN
IL624901Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER