Healthcare Provider Details

I. General information

NPI: 1285722207
Provider Name (Legal Business Name): SHEEJA JAIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 W BOUGHTON RD
BOLINGBROOK IL
60440
US

IV. Provider business mailing address

5909 W 35TH ST
CICERO IL
60804-4163
US

V. Phone/Fax

Practice location:
  • Phone: 630-771-1201
  • Fax: 630-771-1203
Mailing address:
  • Phone: 708-652-2040
  • Fax: 708-652-0058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036106165
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: