1982793436 NPI number — VEENA NAYAK MD SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982793436 NPI number — VEENA NAYAK MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VEENA NAYAK MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DBA SOUTHLAND RHEUMATOLOGY CENTER, LTD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982793436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20060 GOVERNORS DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA FIELDS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60461-1099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-283-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20060 GOVERNORS DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA FIELDS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60461-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-283-2600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JEFFERS
Authorized Official First Name:
WENDI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
708-283-2600

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  036094023 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001635621 . This is a "BLUE SHIELD PROVIDER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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