JAISE THEKKAN POULOSE

FARGO, ND
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 Date2021-03-24
Business Address
JAISE THEKKAN POULOSE M.D.
3000 32ND AVE S
FARGO, ND 58103-6132
Phone number: 701-364-8000
Mailing Address
JAISE THEKKAN POULOSE M.D.
PO BOX 2400
HOPKINSVILLE, KY 42241-2400
Phone number: 270-887-0100