Provider Demographics
NPI:1003924796
Name:JAIN, MADHU B (MD)
Entity Type:Individual
Prefix:
First Name:MADHU
Middle Name:B
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7530 S WOODWARD AVE STE A
Mailing Address - Street 2:WOODRIDGE CLINIC S.C.
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3100
Mailing Address - Country:US
Mailing Address - Phone:630-910-1177
Mailing Address - Fax:630-910-1177
Practice Address - Street 1:7530 S WOODWARD AVE STE A
Practice Address - Street 2:WOODRIDGE CLINIC S.C.
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-3100
Practice Address - Country:US
Practice Address - Phone:630-910-1177
Practice Address - Fax:630-910-1177
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036061831207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
036061831Medicare UPIN
740820Medicare PIN
C44269Medicare UPIN