JAISE THEKKAN POULOSE

EDGEWOOD, KY
NPI1497872675
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207RC0200X Internal Medicine, Critical Care Medicine
(Licence: KY  53941)
Additional Taxonomies207RC0000X Internal Medicine, Cardiovascular Disease
(Licence: ND  11150)
207RC0200X Internal Medicine, Critical Care Medicine
(Licence: MN  50104)
207RP1001X Internal Medicine, Pulmonary Disease
(Licence: LA  MD.207663)
Enumeration Date2007-03-23
Last Update Date2025-08-06
Business Address
JAISE THEKKAN POULOSE M.D.
1 MEDICAL VILLAGE DR
EDGEWOOD, KY 41017-3403
Phone number: 859-757-2927
Mailing Address
JAISE THEKKAN POULOSE M.D.
PO BOX 635283
CINCINNATI, OH 45263-5283
Phone number: 859-757-2927