=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497000871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUMITA JAIN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13431 OLD MERIDIAN ST STE 205
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-1417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-798-0117
-----------------------------------------------------
Fax | 317-762-3414
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6696 E STONEGATE DR
-----------------------------------------------------
City | ZIONSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46077-8196
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-939-7043
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 01081338A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------