Provider Demographics
NPI:1447203153
Name:JOSHI, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:JOSHI
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 1:21720 W LONG GROVE RD
Mailing Address - Street 2:STE. C200
Mailing Address - City:DEER PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3732
Mailing Address - Country:US
Mailing Address - Phone:847-701-3250
Mailing Address - Fax:847-701-3300
Practice Address - Street 1:21720 W LONG GROVE RD
Practice Address - Street 2:STE. C200
Practice Address - City:DEER PARK
Practice Address - State:IL
Practice Address - Zip Code:60010-3732
Practice Address - Country:US
Practice Address - Phone:847-701-3250
Practice Address - Fax:847-701-3300
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115191208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363756275OtherTAX ID
IL131846500OtherDEPARTMENT OF LABOR
IL1619628OtherBCBS PROVIDER
IL1619628OtherBCBS PROVIDER
I32529Medicare UPIN
ILP00349345Medicare ID - Type UnspecifiedRAILROAD MEDICARE
ILK28133Medicare ID - Type UnspecifiedLOCALITY 16 PIN