MEDICARE: BRIAN R CAIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35-061748	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9338635	OTHER	OH	PARTNERS PHYSICIAN GROUP MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1083864144	OTHER	OH	PORTAGE HILL TYPE 2 NPI #
5	1841239274	OTHER	OH	PARTNERS PHYSICIAN GROUP TYPE 2 NPI #

General Provider Information

NPI Number	:	1417951039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN R CAIN M.D.

Provider Business Mailing Address
First Line	:	754 S CLEVELAND AVE STE 300
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-2210
Country	:	US
Telephone Number	:	330-877-3008
Fax Number	:	330-877-3032

Provider Business Practice Location Address
First Line	:	754 S CLEVELAND AVE STE 300
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-2210
Country	:	US
Telephone Number	:	330-877-3008
Fax Number	:	330-877-3032

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/17/2020

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1881698413 — BRENDA S BUIS D.O.
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Directions to “ BRIAN R CAIN M.D.” Practice Location

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