Provider Demographics
NPI:1275610917
Name:JAIN, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:JAIN
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 1:1375 E SCHAUMBURG RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-5166
Mailing Address - Country:US
Mailing Address - Phone:847-352-2344
Mailing Address - Fax:847-352-2369
Practice Address - Street 1:1375 E SCHAUMBURG RD
Practice Address - Street 2:SUITE 120
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-5166
Practice Address - Country:US
Practice Address - Phone:847-352-2344
Practice Address - Fax:847-352-2369
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036045233207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21602458OtherBLUE CROSS BLUE SHIELD
IL036045233Medicaid
IL036045233Medicaid
IL21602458OtherBLUE CROSS BLUE SHIELD