Provider Demographics
NPI:1700886116
Name:DUTTON, JAY M (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:DUTTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 HIGHLAND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1558
Mailing Address - Country:US
Mailing Address - Phone:630-701-3840
Mailing Address - Fax:630-574-8225
Practice Address - Street 1:3800 HIGHLAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1558
Practice Address - Country:US
Practice Address - Phone:630-701-3840
Practice Address - Fax:630-574-8225
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036100227207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036100227Medicaid
IL548580Medicare PIN
ILK21626Medicare PIN
IL212417Medicare PIN
IL040015195Medicare PIN
IL501100Medicare PIN
IL548400Medicare PIN
ILG58652Medicare UPIN
IL036100227Medicaid
ILP00281936Medicare PIN
ILCC3183Medicare PIN
ILK21625Medicare PIN
IL040015194Medicare PIN
IL040015838Medicare PIN