MEDICARE: RUTKUMAR P JANI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	15409	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164405981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTKUMAR P JANI MD

Provider Business Mailing Address
First Line	:	PO BOX 6069
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-6069
Country	:	US
Telephone Number	:	803-419-4949
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 LONGTOWN RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-8550
Country	:	US
Telephone Number	:	803-419-4949
Fax Number	:	803-419-6445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	11/06/2020

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