Basic Information
| Provider Information | |||||||||
| NPI: | 1700891231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOTIANI | ||||||||
| FirstName: | VINOD | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 130 N WEBER RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604401519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306465777 | ||||||||
| FaxNumber: | 6306465729 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 N WEBER RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604401519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6306465777 | ||||||||
| FaxNumber: | 6306465729 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 03/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036-072068 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1508032053 | 01 | IL | TYPE 2 NPI | OTHER | 036072068 | 05 | IL | MEDICAID | 110170972 | 01 | IL | MEDICARE RR | OTHER | 2201614 | 01 | IL | BCBS | OTHER |