Basic Information
| Provider Information | |||||||||
| NPI: | 1619945359 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | SANDEEP | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7050 NW 4TH ST | ||||||||
| Address2: | STE 203 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333172247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9645300848 | ||||||||
| FaxNumber: | 9547915305 | ||||||||
| Practice Location | |||||||||
| Address1: | 7050 NW 4TH ST | ||||||||
| Address2: | STE 203 | ||||||||
| City: | PLANTATION | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333172247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545300848 | ||||||||
| FaxNumber: | 9547915305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 08/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME65687 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | ME65687 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | ME65687 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 379983200 | 05 | FL | MEDICAID |