Provider Demographics
NPI:1932140076
Name:CAIN, PHILIP JEFFREY (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JEFFREY
Last Name:CAIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W HARDING RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1706
Mailing Address - Country:US
Mailing Address - Phone:937-399-8011
Mailing Address - Fax:937-399-7096
Practice Address - Street 1:415 W HARDING RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1706
Practice Address - Country:US
Practice Address - Phone:937-399-8011
Practice Address - Fax:937-399-7096
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002472213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000017632OtherANTHEM
OH0703439Medicaid
OH0703439Medicaid
0144040001Medicare NSC
OH0613272Medicare PIN