MEDICARE: MANUEL G JAIN, MD, LLC

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	207R00000X	Internal Medicine Physician	ME0031133	FL

General Provider Information

NPI Number	:	1871750299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANUEL G JAIN, MD, LLC

Provider Business Mailing Address
First Line	:	321 E ROBERTSON ST
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5253
Country	:	US
Telephone Number	:	813-685-2191
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 S DIXIE DR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-2844
Country	:	US
Telephone Number	:	863-422-8404
Fax Number	:

Authorized Official
Title or Position	:	ACCOUNT REP ASSIST
Name	:	MRS. DALLAS L DUNNE
Credential	:
Telephone Number	:	813-685-2191

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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