Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 63950 | MN |
Y | 111NI0900X | Internist | 63950 | MN |
N | 207R00000X | Internist | 64292-20 | WI |
N | 111NI0900X | Internist | 64292-20 | WI |
N | 207U00000X | Nuclear Medicine Specialist | 64292-20 | WI |
NPI | 1588955843 |
---|---|
Provider Name | Aditya Jain |
First Address | Madison, WI 53705-1804 |
Second Address | Minneapolis, MN 55455-0363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2011 |
Last Update Date | 30/07/2018 |