Provider Demographics
NPI:1295713600
Name:JAIN, ANUDEEP (MD)
Entity type:Individual
Prefix:DR
First Name:ANUDEEP
Middle Name:
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 1:7026 OLD KATY RD STE 276
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2187
Mailing Address - Country:US
Mailing Address - Phone:713-621-7436
Mailing Address - Fax:713-963-9051
Practice Address - Street 1:7026 OLD KATY RD STE 276
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2187
Practice Address - Country:US
Practice Address - Phone:281-440-5158
Practice Address - Fax:281-440-8549
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH81512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1052474-01Medicaid
TX86R663Medicare ID - Type UnspecifiedINDIVIDUAL M/C PROVIDER #
TX1052474-01Medicaid