Provider Demographics
NPI:1376539106
Name:NAYAK, VEENA (MD)
Entity Type:Individual
Prefix:DR
First Name:VEENA
Middle Name:
Last Name:NAYAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20060 GOVERNORS DR
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1099
Mailing Address - Country:US
Mailing Address - Phone:708-283-2600
Mailing Address - Fax:708-833-7248
Practice Address - Street 1:20060 GOVERNORS DR
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1029
Practice Address - Country:US
Practice Address - Phone:708-283-2600
Practice Address - Fax:708-833-7248
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2021-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094023207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635621OtherBLUE SHIELD PROVIDER
IL212541Medicare PIN
ILG42358Medicare UPIN
DE2337Medicare PIN