Provider Demographics
NPI:1952563512
Name:AMIT D VYAS MD SC
Entity Type:Organization
Organization Name:AMIT D VYAS MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:D
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-747-9190
Mailing Address - Street 1:1917 MIDWEST CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2525
Mailing Address - Country:US
Mailing Address - Phone:219-992-9737
Mailing Address - Fax:219-992-9738
Practice Address - Street 1:2315 E 93RD ST STE 237
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3919
Practice Address - Country:US
Practice Address - Phone:773-221-2700
Practice Address - Fax:773-221-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084893207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200493200AMedicaid
IL036084893Medicaid
IL036084893Medicaid
ING46258Medicare UPIN
IN200493200AMedicaid
IL237910Medicare PIN