Provider Demographics
NPI:1194832212
Name:MAKER, VIJAY K
Entity Type:Individual
Prefix:DR
First Name:VIJAY
Middle Name:K
Last Name:MAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60022-1215
Mailing Address - Country:US
Mailing Address - Phone:773-296-5346
Mailing Address - Fax:773-296-5570
Practice Address - Street 1:3000 N HALSTED ST
Practice Address - Street 2:STE 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5194
Practice Address - Country:US
Practice Address - Phone:773-296-5346
Practice Address - Fax:773-296-5570
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045277208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0021603676OtherBLUE CROSS
IL036045277Medicaid
IL0021603676OtherBLUE CROSS
ILC38452Medicare UPIN