Healthcare Provider Details

I. General information

NPI: 1255330361
Provider Name (Legal Business Name): DINESH K JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 06/13/2025
Certification Date: 06/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17148 HARLEM AVE
TINLEY PARK IL
60477-3331
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-0001
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-1200
  • Fax: 708-429-4845
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-067930
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036067930
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number036067930
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: