Provider Demographics
NPI:1093835621
Name:RENU JAIN MD
Entity Type:Organization
Organization Name:RENU JAIN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENU
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-530-2224
Mailing Address - Street 1:33 N ADDISON RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-3875
Mailing Address - Country:US
Mailing Address - Phone:630-530-2224
Mailing Address - Fax:630-530-2267
Practice Address - Street 1:33 N ADDISON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3875
Practice Address - Country:US
Practice Address - Phone:630-530-2224
Practice Address - Fax:630-530-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty