1760464390 NPI number — DR. JAYANT V GINDE MD

Table of content: DR. JAYANT V GINDE MD (NPI 1760464390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760464390 NPI number — DR. JAYANT V GINDE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GINDE
Provider First Name:
JAYANT
Provider Middle Name:
V
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1760464390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
62647 COLLECTION CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60693-0626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-335-4000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4440 W 95TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK LAWN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60453-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-000-0000
Provider Business Practice Location Address Fax Number:
708-000-0000
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0001X , with the licence number:  036047890 , 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: 9200004027 . This is a "RR MEDICARE HITECH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 920000278 . This is a "RR MEDICARE CONS RAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036047890 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 320000298 . This is a "RR MEDICARE ICRO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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