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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 4 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.

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Identifiers

StateTypeNumberIssuer
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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