Individual
SUSHIL JAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11050 PARKVIEW CIRCLE DR, FORT WAYNE, IN 46845
(833) 724-8326
(260) 425-6845
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
01058235
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000263296
OH MEDICAID UNISON
OH
05
—
061794
—
OH
01
—
0617943
OH MEDICAID MOLINA
OH
01
—
310917085202
OH MEDICAID CARESOURCE
OH
05
—
3810014440
—
WV
Enumeration date
09/08/2005
Last updated
10/10/2022
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