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General NPI Number Information
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NPI Number | 1174222830
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Entity Type | Organization
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Legal Business Name | PRESTIGE 2
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 11360 BROADWAY
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City | CROWN POINT
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State | IN
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Zip | 46307-7197
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Country | US
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Telephone | 219-301-2624
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 578220
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City | CHICAGO
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State | IL
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Zip | 60657-7303
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Country | US
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Telephone | 773-935-4700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAY K JOSHI
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Credential | MD
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Telephone | 630-430-8024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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