Provider Demographics
NPI:1427085570
Name:JAIN, THAN MAL (MD)
Entity type:Individual
Prefix:
First Name:THAN
Middle Name:MAL
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638269
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:330-722-8707
Mailing Address - Fax:330-723-5679
Practice Address - Street 1:970 E WASHINGTON ST
Practice Address - Street 2:STE 2-E
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-722-8707
Practice Address - Fax:330-723-5679
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH046687207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0559131Medicaid
OH060027690OtherRAILROAD MEDICARE
OH0559131Medicaid
OH060027690OtherRAILROAD MEDICARE