Provider Demographics
NPI:1619079977
Name:JAIN, RENU (MD)
Entity Type:Individual
Prefix:DR
First Name:RENU
Middle Name:
Last Name:JAIN
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 1:219 WOODGLEN LANE
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1530
Mailing Address - Country:US
Mailing Address - Phone:630-941-7512
Mailing Address - Fax:630-941-7513
Practice Address - Street 1:33 N ADDISON ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101
Practice Address - Country:US
Practice Address - Phone:630-530-2224
Practice Address - Fax:630-530-2267
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063763Medicaid
IL036063763Medicaid
703660Medicare ID - Type Unspecified