Provider Demographics
NPI:1215412796
Name:JAIN-POSTER, KETAN (STUDENT)
Entity Type:Individual
Prefix:
First Name:KETAN
Middle Name:
Last Name:JAIN-POSTER
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHWESTERN MEDICINE MCGAW MEDICAL CENTER
Mailing Address - Street 2:240 E HURON STREET, SUITE 1-200 CHICAGO IL 60611
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-503-7975
Mailing Address - Fax:
Practice Address - Street 1:NORTHWESTERN MEDICINE MCGAW MEDICAL CENTER
Practice Address - Street 2:240 E HURON STREET, SUITE 1-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-503-7975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program