Healthcare Provider Details

I. General information

NPI: 1396716916
Provider Name (Legal Business Name): VINAY NIJHAWAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-5222
US

IV. Provider business mailing address

1740 W TAYLOR ST.
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 715-577-4678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.097791
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036097791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: