Individual
PANKAJ JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3800 W 203RD ST, SUITE 202, OLYMPIA FIELDS, IL 60461-1184
(708) 679-2660
(708) 503-3861
Mailing address
1040 SIERRA DR, SUITE 400, GREENWOOD, IN 46143-7240
(317) 528-4800
(317) 865-8319
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036121222
IL
207RP1001X
Pulmonary Disease Physician
39423
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000365405
BLUE CROSS BLUE SHIELD
KY
05
—
036121222
—
IL
01
—
05-0540914
TAX ID
IL
05
—
64100852
—
KY
01
—
P00256659
RAILROAD MEDICARE
KY
01
—
P00723355
RAIL ROAD MEDICARE
IL
Enumeration date
03/20/2006
Last updated
08/29/2013
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