Provider Demographics
NPI:1982793436
Name:VEENA NAYAK MD SC
Entity Type:Organization
Organization Name:VEENA NAYAK MD SC
Other - Org Name:DBA SOUTHLAND RHEUMATOLOGY CENTER, LTD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WENDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEFFERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-283-2600
Mailing Address - Street 1:20060 GOVERNORS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1099
Mailing Address - Country:US
Mailing Address - Phone:708-283-2600
Mailing Address - Fax:
Practice Address - Street 1:20060 GOVERNORS DR STE 300
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1099
Practice Address - Country:US
Practice Address - Phone:708-283-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036094023207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001635621OtherBLUE SHIELD PROVIDER
IL001635621OtherBLUE SHIELD PROVIDER
IL212541Medicare PIN
DE2337Medicare PIN