Provider Demographics
NPI:1225135940
Name:ARYA, JAI DEV (MD)
Entity Type:Individual
Prefix:DR
First Name:JAI
Middle Name:DEV
Last Name:ARYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-4247
Mailing Address - Country:US
Mailing Address - Phone:773-995-3405
Mailing Address - Fax:773-995-3408
Practice Address - Street 1:67 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4247
Practice Address - Country:US
Practice Address - Phone:773-995-3405
Practice Address - Fax:773-995-3408
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X, 207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A6639420OtherFEDERAL DEA NUMBER
IL493090Medicare PIN
D13150Medicare UPIN