MEDICARE: UMANG JAIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	036156163	IL

General Provider Information

NPI Number	:	1225428857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UMANG JAIN

Provider Business Mailing Address
First Line	:	474 N LAKE SHORE DR
Second Line	:	APT 2611
City	:	CHICAGO
State	:	IL
Zip	:	60611-3400
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	474 N LAKE SHORE DR
Second Line	:	APT 2611
City	:	CHICAGO
State	:	IL
Zip	:	60611-3400
Country	:	US
Telephone Number	:	617-827-5581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2015
Last Update Date	:	08/23/2021

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