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General NPI Number Information
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NPI Number | 1033358262
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Entity Type | Organization
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Legal Business Name | SANDEEP JAIN MD PA
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 7420 NW 5TH ST SUITE 103
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City | PLANTATION
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State | FL
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Zip | 33317-1611
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Country | US
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Telephone | 954-792-0304
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Fax | 954-587-8686
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Provider Business Mailing Address
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Address Line | 7420 NW 5TH ST SUITE 103
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City | PLANTATION
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State | FL
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Zip | 33317-1611
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Country | US
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Telephone | 954-792-0304
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Fax | 954-587-8686
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Authorized Official
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Title or Position | OWNER
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Name | SANDEEP JAIN
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Credential | MD
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Telephone | 954-792-0304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | ME65687
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License Number State | FL
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