Basic Information
| Provider Information | |||||||||
| NPI: | 1306935002 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAIN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 LAWN AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ELKHART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465142450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742932893 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3301 COUNTY ROAD 6 E | ||||||||
| Address2: | |||||||||
| City: | ELKHART | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465147673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742649635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 08/30/2011 | ||||||||
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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 | 207V00000X | 01023834A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000697645 | 01 | IN | ANTHEM - FWO | OTHER | 100357650 | 05 | IN | MEDICAID | 000000697652 | 01 | IN | ANTHEM - FPA | OTHER |