Provider Demographics
NPI:1487698809
Name:JAIN, SUDHIR K (MD)
Entity type:Individual
Prefix:DR
First Name:SUDHIR
Middle Name:K
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-1291
Mailing Address - Fax:314-286-1949
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DIV IM CARDIOLOGY, STE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-362-1291
Practice Address - Fax:314-286-1949
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO101411207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205943111Medicaid
IL036086541Medicaid
MO000093029Medicare PIN
IL036086541Medicaid
MOP00184846Medicare PIN
MO922810183Medicare PIN