Provider Demographics
NPI:1043552706
Name:JAIN, AMIT (MD, MBA)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5307
Mailing Address - Country:US
Mailing Address - Phone:615-227-3000
Mailing Address - Fax:
Practice Address - Street 1:6206 W BELL RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3750
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:602-863-5851
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL2445208000000X
390200000X
AZ54746208000000X
TN69601208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ54746OtherARIZONA MD LICENSE
TN69601OtherTN STATE LICENSE
CAA148127OtherCA PHYSICIAN AND SURGEON LICENSE
NVLL2445OtherMEDICAL RESIDENT STUDENT LICENSE