Healthcare Provider Details

I. General information

NPI: 1295821585
Provider Name (Legal Business Name): ANUJ JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST STE 600
LINCOLN NE
68506-1275
US

IV. Provider business mailing address

PO BOX 6607
LINCOLN NE
68506-0607
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-3333
  • Fax:
Mailing address:
  • Phone: 402-483-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20428
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: