Healthcare Provider Details

I. General information

NPI: 1801849112
Provider Name (Legal Business Name): VIPIN JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 CENTURY PLAZA RD STE 265
INDIANAPOLIS IN
46254-5471
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-216-2700
  • Fax: 317-216-2777
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01057123A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: