Provider Demographics
NPI:1356390512
Name:JAIN, NEAL (MD)
Entity type:Individual
Prefix:
First Name:NEAL
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 1:4915 E BASELINE RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2965
Mailing Address - Country:US
Mailing Address - Phone:480-626-6600
Mailing Address - Fax:480-626-6604
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2966
Practice Address - Country:US
Practice Address - Phone:480-626-6600
Practice Address - Fax:480-626-6604
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46685-020207K00000X
AZ42305207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60229OtherDEAN HEALTH INSURANCE
WI34556400Medicaid
AZZ134798Medicare PIN
H89567Medicare UPIN
WI090074150Medicare PIN
WI60229OtherDEAN HEALTH INSURANCE
WI011257085Medicare PIN
WIP00349799Medicare PIN