Healthcare Provider Details

I. General information

NPI: 1437513470
Provider Name (Legal Business Name): JAI NEBHRAJANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 W MAXWELL ST
CHICAGO IL
60607-5002
US

IV. Provider business mailing address

285 ROOSEVELT RD STE A
GLEN ELLYN IL
60137-5618
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-2901
  • Fax:
Mailing address:
  • Phone: 630-469-0045
  • Fax: 630-469-0645

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 Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036150261
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: