Provider Demographics
NPI:1750478392
Name:JAIN, NITIN (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 361095
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32936-1095
Mailing Address - Country:US
Mailing Address - Phone:321-254-6338
Mailing Address - Fax:321-254-6341
Practice Address - Street 1:2010 W EAU GALLIE BLVD UNIT 106
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4033
Practice Address - Country:US
Practice Address - Phone:321-254-6338
Practice Address - Fax:321-254-6341
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME85400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78737OtherBCBS FL
FL78737OtherBCBS FL
FLH76383Medicare UPIN