Provider Demographics
NPI:1053388116
Name:PAIK, JAY C L (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:C L
Last Name:PAIK
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:PO BOX 3566
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0566
Mailing Address - Country:US
Mailing Address - Phone:219-836-6411
Mailing Address - Fax:219-836-6415
Practice Address - Street 1:800 MACARTHUR BLVD
Practice Address - Street 2:#15
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2917
Practice Address - Country:US
Practice Address - Phone:219-836-6411
Practice Address - Fax:219-836-6415
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030770A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB29096Medicare UPIN
IN492730Medicare ID - Type Unspecified