Provider Demographics
NPI:1720250343
Name:SUSHIL K JAIN MD INC
Entity Type:Organization
Organization Name:SUSHIL K JAIN MD INC
Other - Org Name:SUSHIL K JAIN MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-723-3338
Mailing Address - Street 1:5041 VICTOR DRIVE
Mailing Address - Street 2:UNIT C
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256
Mailing Address - Country:US
Mailing Address - Phone:330-723-3338
Mailing Address - Fax:330-722-5439
Practice Address - Street 1:5041 VICTOR DRIVE
Practice Address - Street 2:UNIT C
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-723-3338
Practice Address - Fax:330-722-5439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty