Provider Demographics
NPI:1356669923
Name:JAS BRAR M.D., S.C.
Entity Type:Organization
Organization Name:JAS BRAR M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JASDIP
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-545-4935
Mailing Address - Street 1:201 ASTORIA CT
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5177
Mailing Address - Country:US
Mailing Address - Phone:630-545-4935
Mailing Address - Fax:630-592-2239
Practice Address - Street 1:701 WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-1405
Practice Address - Country:US
Practice Address - Phone:630-545-4935
Practice Address - Fax:630-592-2239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2019-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.120864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036120864Medicaid