Provider Demographics
NPI:1992965156
Name:JAIN, VIKAS (MD)
Entity type:Individual
Prefix:
First Name:VIKAS
Middle Name:
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 1:4645 AVON LN STE 340
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1215
Mailing Address - Country:US
Mailing Address - Phone:214-308-1525
Mailing Address - Fax:855-838-5251
Practice Address - Street 1:4645 AVON LN STE 340
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1215
Practice Address - Country:US
Practice Address - Phone:214-308-1525
Practice Address - Fax:855-838-5251
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140333207QS1201X, 2083B0002X
CAA115489207QS1201X, 2084S0012X
TXR7027207QS1201X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036140333Medicaid