Provider Demographics
NPI:1477555092
Name:JAIN, VIKAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKAS
Middle Name:C
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1643 LANCASTER DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3593
Mailing Address - Country:US
Mailing Address - Phone:817-329-7670
Mailing Address - Fax:817-416-0145
Practice Address - Street 1:1643 LANCASTER DR
Practice Address - Street 2:SUITE 203
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3593
Practice Address - Country:US
Practice Address - Phone:817-329-7670
Practice Address - Fax:817-416-0145
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2011-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL4468207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153131104Medicaid
TX8CM936OtherBCBSTX
TX153131105Medicaid
TXTXB121377Medicare PIN
TX8CM936OtherBCBSTX
TX153131105Medicaid
TXP00927073Medicare PIN