Poulose, Jaise Thekkan
Poulose, Jaise Thekkan is an individual health care provider with primary practice located at 3000 32Nd Ave S , Fargo ND 58103-6132. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Critical Care Medicine, Allopathic & Osteopathic Physicians / Pulmonary Disease. Allopathic & Osteopathic Physicians / Critical Care Medicine is his primary health care specialty. Poulose, Jaise Thekkan can be contacted via phone (701) 364-8000.Contact Information
Primary practice address
3000 32Nd Ave S
Fargo ND 58103-6132
Phone: (701) 364-8000
Fax: (701) 364-8078
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 11150 | North Dakota |
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 50104 | Minnesota |
| Allopathic & Osteopathic Physicians / Pulmonary Disease | 207RP1001X | MD.207663 | Louisiana |
| Allopathic & Osteopathic Physicians / Critical Care Medicine | 207RC0200X | 53941 | Kentucky |
Profile Details
| NPI number | 1497872675 |
|---|---|
| LBN Legal business name | Poulose, Jaise Thekkan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 23rd, 2007 |
| Last updated | Mar 24th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497872675 | NPPES |
| Kentucky | MEDICAID | 7100672860 | |
| Kentucky | MEDICAID | ENROLLED | |
| Kentucky | MEDICAID | ENROLLED | |
| Kentucky | MEDICAID | N714361 | |
| Kentucky | MEDICAID | 35190900 | |
| Kentucky | MEDICAID | 913427000 | |
| Kentucky | MEDICAID | 10502 |
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