Provider Demographics
NPI:1861591356
Name:VYAS, AMIT D (MD SC)
Entity type:Individual
Prefix:
First Name:AMIT
Middle Name:D
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 MIDWEST CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2525
Mailing Address - Country:US
Mailing Address - Phone:219-992-9737
Mailing Address - Fax:219-992-9738
Practice Address - Street 1:2315 E 93RD ST STE 236
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3984
Practice Address - Country:US
Practice Address - Phone:773-221-2700
Practice Address - Fax:773-221-5701
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01045391A207RI0011X
IL036084893207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364274312OtherTAX ID
IL036084893Medicaid
IN200493200AMedicaid
IN364274312OtherTAX ID
IN260990AMedicare PIN
IL237910Medicare PIN
ILG46258Medicare UPIN
ING46258Medicare UPIN