JAISE THEKKAN POULOSE M.D.
Individual Provider (NPI-1)
Active
Internal Medicine, Critical Care Medicine
Provider Information
- NPI Number
1497872675- Provider Type
- Individual Provider (NPI-1)
- Credentials
- M.D.
- Status
- Active
Contact & Location
- Address
- 1 MEDICAL VILLAGE DR, EDGEWOOD, KY, 410173403
- Phone
- (859) 757-2927
- Fax
- (859) 341-0203
Specialties & Taxonomies
Internal Medicine, Cardiovascular Disease
License: ND #11150
Internal Medicine, Critical Care Medicine
License: MN #50104
Internal Medicine, Pulmonary Disease
License: LA #MD.207663
Internal Medicine, Critical Care Medicine
Primary License: KY #53941