Healthcare Provider Details

I. General information

NPI: 1811120355
Provider Name (Legal Business Name): NITIN JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51307 GRATIOT AVE
CHESTERFIELD MI
48051-2079
US

IV. Provider business mailing address

2825 CHARNWOOD DR
TROY MI
48098-2112
US

V. Phone/Fax

Practice location:
  • Phone: 586-275-9460
  • Fax:
Mailing address:
  • Phone: 313-969-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301094391
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301094391
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: