Provider Demographics
NPI:1497047435
Name:JOSHI, JAY KAUSHIK (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:KAUSHIK
Last Name:JOSHI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 578220
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7303
Mailing Address - Country:US
Mailing Address - Phone:773-935-4700
Mailing Address - Fax:
Practice Address - Street 1:11360 BROADWAY
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7197
Practice Address - Country:US
Practice Address - Phone:219-301-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074818A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01074818AMedicaid
IN01074818AMedicaid
IN1497047435Medicare PIN