Healthcare Provider Details

I. General information

NPI: 1598850810
Provider Name (Legal Business Name): RUPESH JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 N UNION BLVD., STE A
COLORADO SPRINGS CO
80920
US

IV. Provider business mailing address

6432 MEDICINE SPRINGS
COLORADO SPRINGS CO
80918
US

V. Phone/Fax

Practice location:
  • Phone: 719-535-9990
  • Fax: 719-535-9980
Mailing address:
  • Phone: 719-535-9990
  • Fax: 719-535-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number42150
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: