Basic Information
| Provider Information | |||||||||
| NPI: | 1588955843 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | ADITYA | ||||||||
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| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 UNIVERSITY HOUSES APT B | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537051804 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 500 HARVARD ST SE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122733000 | ||||||||
| FaxNumber: | 6122734370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2011 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | 64292-20 | WI | N | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207R00000X | 64292-20 | WI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 2085R0202X | 64292-20 | WI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 207R00000X | 63950 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.