Provider Demographics
NPI:1811085822
Name:JAIN, SHISHIR (MD)
Entity type:Individual
Prefix:DR
First Name:SHISHIR
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-4163
Mailing Address - Country:US
Mailing Address - Phone:708-652-2040
Mailing Address - Fax:708-652-0058
Practice Address - Street 1:5909 W 35TH ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-4163
Practice Address - Country:US
Practice Address - Phone:708-652-2040
Practice Address - Fax:708-652-0058
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3698420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110202292OtherRR MEDICARE PIN
IL667OtherCHICAGO HEALTH SYSTEMS (CHS)
IL277392OtherWELLCARE HMO
IL3698420OtherSTATE LICENCE NO.
IL003698420OtherBLUE SHEILD
IL036098420Medicaid
IL667OtherCHICAGO HEALTH SYSTEMS (CHS)
IL036098420Medicaid
ILL73929Medicare PIN
IL277392OtherWELLCARE HMO