Healthcare Provider Details

I. General information

NPI: 1194285247
Provider Name (Legal Business Name): AKASH JINDAL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2019
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 N MAY ST STE 110
CHICAGO IL
60607-1237
US

IV. Provider business mailing address

301 W GRAND AVE
CHICAGO IL
60654-4640
US

V. Phone/Fax

Practice location:
  • Phone: 312-757-4647
  • Fax:
Mailing address:
  • Phone: 408-394-0283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8266-851
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number125.074880
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: