Basic Information
Provider Information
NPI: 1003018201
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JAIN
FirstName: RAHUL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2723 S 7TH ST STE A
Address2:  
City: TERRE HAUTE
State: IN
PostalCode: 478023558
CountryCode: US
TelephoneNumber: 8122381730
FaxNumber:  
Practice Location
Address1: 2723 S 7TH ST STE A
Address2:  
City: TERRE HAUTE
State: IN
PostalCode: 478023558
CountryCode: US
TelephoneNumber: 8122328164
FaxNumber: 8122346391
Other Information
ProviderEnumerationDate: 06/01/2007
LastUpdateDate: 05/30/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XD0068254MDN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0001X01071122AINY Allopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology

ID Information
IDTypeStateIssuerDescription
006038405OH MEDICAID
H07605001OHMEDICARE PTANOTHER


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