MEDICARE: DR. JAY M DUTTON M.D.

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	207Y00000X	Otolaryngology Physician	036100227	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700886116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY M DUTTON M.D.

Provider Business Mailing Address
First Line	:	3800 HIGHLAND AVE STE 105
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1558
Country	:	US
Telephone Number	:	630-701-3840
Fax Number	:	630-574-8225

Provider Business Practice Location Address
First Line	:	3800 HIGHLAND AVE STE 105
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1558
Country	:	US
Telephone Number	:	630-701-3840
Fax Number	:	630-574-8225

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	12/20/2021

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