Provider Demographics
NPI:1093942534
Name:JAIN, ANSHU K (MD)
Entity Type:Individual
Prefix:
First Name:ANSHU
Middle Name:K
Last Name:JAIN
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 1:122 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7016
Mailing Address - Country:US
Mailing Address - Phone:606-836-0202
Mailing Address - Fax:
Practice Address - Street 1:122 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7016
Practice Address - Country:US
Practice Address - Phone:606-836-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY451722085R0203X
MAL-240344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine