Basic Information
| Provider Information | |||||||||
| NPI: | 1356437941 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7502 STATE RD STE 2210A | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452552596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136242070 | ||||||||
| FaxNumber: | 5136242077 | ||||||||
| Practice Location | |||||||||
| Address1: | 7502 STATE RD STE 2210A | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452552596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136242070 | ||||||||
| FaxNumber: | 5136242077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 01/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 35.083789 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 35083789 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 000000571669 | 01 | OH | ANTHEM | OTHER | 2574718 | 05 | OH | MEDICAID |