MEDICARE: SANJAY K. JAIN M.D.

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	207R00000X	Internal Medicine Physician	33212	KY
2	207RG0100X	Gastroenterology Physician	33212	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00424387	OTHER	KY	RAILROAD MEDICARE - KY

Other Identifiers

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

General Provider Information

NPI Number	:	1578504817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY K. JAIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 909
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40201-0909
Country	:	US
Telephone Number	:	502-416-0207
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-3100
Country	:	US
Telephone Number	:	502-416-0207
Fax Number	:

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	02/27/2025

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