=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124602255
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. JAINISH SURESH SONI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2021
-----------------------------------------------------
Last Update Date | 07/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 MERCY HEALTH BLVD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45211-1103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-841-9647
-----------------------------------------------------
Fax | 330-841-9645
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | EAST MARKET STREET, 7TH FLOOR 1350
-----------------------------------------------------
City | WARREN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-841-9647
-----------------------------------------------------
Fax | 330-841-9645
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 35.150070
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------