Provider Demographics
NPI:1700891231
Name:MOTIANI, VINOD G (MD)
Entity Type:Individual
Prefix:DR
First Name:VINOD
Middle Name:G
Last Name:MOTIANI
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 1:130 N WEBER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1519
Mailing Address - Country:US
Mailing Address - Phone:630-646-5777
Mailing Address - Fax:630-646-5729
Practice Address - Street 1:130 N WEBER RD STE 100
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1519
Practice Address - Country:US
Practice Address - Phone:630-646-5777
Practice Address - Fax:630-646-5729
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-072068207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1508032053OtherTYPE 2 NPI
IL036072068Medicaid
IL110170972OtherMEDICARE RR
IL2201614OtherBCBS
IL776670Medicare PIN
ILC49407Medicare UPIN