| NPI | 1255582755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN G POLO Physician 502-629-4525 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006356) |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3008115) | |
| 207R00000X Internal Medicine (Licence: KY 36067) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2014-06-16 |