MEDICARE: DR. ADITYA NILESH PAI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.033371	IL

General Provider Information

NPI Number	:	1659048320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADITYA NILESH PAI

Provider Business Mailing Address
First Line	:	23806 SPRINGS CT APT 103
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60585-2262
Country	:	US
Telephone Number	:	510-388-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	2937 IL-178
Second Line	:
City	:	NORTH UTICA
State	:	IL
Zip	:	61373
Country	:	US
Telephone Number	:	815-993-3101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	09/05/2021

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