Healthcare Provider Details

I. General information

NPI: 1396736054
Provider Name (Legal Business Name): JITENDRA M AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N SPENCER ST
RUSHVILLE IN
46173
US

IV. Provider business mailing address

PO BOX 245 725 N SPENCER ST
RUSHVILLE IN
46173
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-5996
  • Fax: 765-932-4996
Mailing address:
  • Phone: 765-932-5996
  • Fax: 765-932-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030547A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01030547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: