Provider Demographics
NPI:1801152111
Name:PADATH, JEENA J (MD)
Entity type:Individual
Prefix:DR
First Name:JEENA
Middle Name:J
Last Name:PADATH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:211 WAUKEGAN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2724
Mailing Address - Country:US
Mailing Address - Phone:847-242-6600
Mailing Address - Fax:847-242-6605
Practice Address - Street 1:211 WAUKEGAN RD STE 200
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093
Practice Address - Country:US
Practice Address - Phone:847-242-6600
Practice Address - Fax:847-242-6605
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036138567207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400246113Medicare PIN