Provider Demographics
NPI:1508032053
Name:VINOD MOTIANI MD SC
Entity Type:Organization
Organization Name:VINOD MOTIANI MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-834-7232
Mailing Address - Street 1:404 W BOUGHTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1898
Mailing Address - Country:US
Mailing Address - Phone:815-834-7232
Mailing Address - Fax:815-834-1307
Practice Address - Street 1:404 W BOUGHTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1898
Practice Address - Country:US
Practice Address - Phone:815-834-7232
Practice Address - Fax:815-834-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-072068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2201614OtherBCBS
IL1508032053OtherTYPE 2 NPI
IL036072068Medicaid
IL110170972OtherMEDICARE RR
IL1508032053OtherTYPE 2 NPI
2201614OtherBCBS