Provider Demographics
NPI:1730382995
Name:INDIRA D NAIR MD SC
Entity type:Organization
Organization Name:INDIRA D NAIR MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF COORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:INDIRA
Authorized Official - Middle Name:DEVI
Authorized Official - Last Name:NAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-518-9393
Mailing Address - Street 1:8565 W DEMPSTER ST
Mailing Address - Street 2:SUIT # 105
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-518-9393
Mailing Address - Fax:847-518-9395
Practice Address - Street 1:8565 W DEMPSTER ST
Practice Address - Street 2:SUIT # 105
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-518-9393
Practice Address - Fax:847-518-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306880455OtherINDIVIDUAL NPI
AN2572863OtherDEA
C47379Medicare UPIN
AN2572863OtherDEA