Provider Demographics
NPI:1255330361
Name:JAIN, DINESH K (MD)
Entity type:Individual
Prefix:DR
First Name:DINESH
Middle Name:K
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 1:16532 OAK PARK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2268
Mailing Address - Country:US
Mailing Address - Phone:708-429-2220
Mailing Address - Fax:708-342-1521
Practice Address - Street 1:16532 OAK PARK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1918
Practice Address - Country:US
Practice Address - Phone:708-429-2220
Practice Address - Fax:708-342-1521
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067930207RA0401X, 207RG0300X
IL036-067930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01628096OtherBCBSIL GROUP #
IL036067930Medicaid
ILD16755Medicare UPIN
IL01628096OtherBCBSIL GROUP #
IL110224177Medicare PIN
IL210867Medicare PIN