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General NPI Number Information
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NPI Number | 1114166733
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Entity Type | Organization
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Legal Business Name | MUDIT JAIN MD PA
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 300 NW 70TH AVE SUITE 105
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City | PLANTATION
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State | FL
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Zip | 33317-2384
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Country | US
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Telephone | 954-585-6292
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Fax | 954-585-6290
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Provider Business Mailing Address
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Address Line | 300 NW 70TH AVE SUITE 105
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City | PLANTATION
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State | FL
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Zip | 33317-2384
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Country | US
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Telephone | 954-585-6292
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Fax | 954-585-6290
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Authorized Official
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Title or Position | MD
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Name | MUDIT JAIN
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Credential |
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Telephone | 954-585-6292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | ME75960
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License Number State | FL
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