Provider Demographics
NPI:1861596363
Name:KEDAINIS, DALIUS (MD FACP)
Entity type:Individual
Prefix:DR
First Name:DALIUS
Middle Name:
Last Name:KEDAINIS
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:16519 S ROUTE 59 STE D
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-2606
Practice Address - Country:US
Practice Address - Phone:815-436-4208
Practice Address - Fax:815-436-5025
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114940174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114940Medicaid
MO507216703Medicaid
MOP00410109OtherRAILROAD MEDICARE
ILIL2489002Medicare PIN
MO966155259Medicare PIN
IL206017033Medicare PIN
MOP00410109OtherRAILROAD MEDICARE