Provider Demographics
NPI:1083000350
Name:INTEGRA HEALTHCARE SC
Entity Type:Organization
Organization Name:INTEGRA HEALTHCARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SACHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-623-7590
Mailing Address - Street 1:5 TIMBERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2463
Mailing Address - Country:US
Mailing Address - Phone:847-858-2083
Mailing Address - Fax:224-235-4415
Practice Address - Street 1:2504 WASHINGTON ST STE 102
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4960
Practice Address - Country:US
Practice Address - Phone:847-623-7590
Practice Address - Fax:847-623-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.128223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty