Provider Demographics
NPI:1902011943
Name:JAIN, RAJAT KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJAT
Middle Name:KUMAR
Last Name:JAIN
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 1:1112 W WELLINGTON AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4338
Mailing Address - Country:US
Mailing Address - Phone:614-214-4661
Mailing Address - Fax:
Practice Address - Street 1:633 EMERSON ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60208-0844
Practice Address - Country:US
Practice Address - Phone:847-491-8100
Practice Address - Fax:847-491-2120
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.094147207R00000X, 208000000X
IL036.133898207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics