Provider Demographics
NPI:1396779294
Name:JAIN, MUKESH C (MD)
Entity type:Individual
Prefix:DR
First Name:MUKESH
Middle Name:C
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 N WABASH AVE
Mailing Address - Street 2:STE 1416
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602
Mailing Address - Country:US
Mailing Address - Phone:312-726-9518
Mailing Address - Fax:312-726-9536
Practice Address - Street 1:111 N WABASH AVE
Practice Address - Street 2:STE 1416
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602
Practice Address - Country:US
Practice Address - Phone:312-726-9518
Practice Address - Fax:312-726-9536
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036055609207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055609Medicaid
IL036055609Medicaid
D14029Medicare UPIN