Provider Demographics
NPI:1013027309
Name:JAIN, ANIL K (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
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 1:300 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-1000
Mailing Address - Country:US
Mailing Address - Phone:734-751-3037
Mailing Address - Fax:734-591-3182
Practice Address - Street 1:7720 E BELLEVIEW AVE STE B300
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2615
Practice Address - Country:US
Practice Address - Phone:303-942-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00610102084P0800X
MI43010482102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE59305Medicare UPIN
MI0828610Medicare ID - Type Unspecified