JAISE THEKKAN POULOSE (NPI# 1497872675) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1497872675 |
Entity Type | Individual |
Full Name | JAISE THEKKAN POULOSE |
Credential | M.D. |
Practice Address |
3000 32nd Ave S Fargo ND 58103-6132 |
Mailing Address |
1202 Louisiana Ave Shreveport LA 71101-3910 |
Practice Telephone | 7013648000 |
Practice Fax Number | 7013648078 |
Mailing Telephone | 3182128546 |
Enumeration Date | 2007-03-23 |
Last Update Date | 2020-06-22 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
11150 | ND | Allopathic & Osteopathic Physicians |
N | 207RC0200X |
Internal Medicine Specialization: Critical Care Medicine |
50104 | MN | Allopathic & Osteopathic Physicians |
Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
MD.207663 | LA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
ND | N714361 | 05 | |
MN | 913427000 | 05 | |
MN | ENROLLED | 05 | |
IA | ENROLLED | 05 | |
ND | 10502 | 05 | |
WI | 35190900 | 05 |
Address | Telephone Number | Fax Number |
---|---|---|
320 W 18th St, Hopkinsville, KY 422401965 | 2708870100 |
Street Address |
3000 32ND AVE S |
City | FARGO |
State | ND |
Zip Code | 58103-6132 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073506648 | Randy K Metcalf | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2005-08-29 |
1861006504 | Hallie M Tiffany | Nurse Practitioner | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-09-01 |
1144846452 | Andrea Patrice Solberg | Nurse Practitioner | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-06-23 |
1669098976 | Nathaniel James Piersol | Nurse Anesthetist, Certified Registered | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-06-23 |
1710503545 | Emily Olivia Miranda | Nurse Practitioner | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-06-17 |
1619500642 | Collin Docter | Physical Therapist | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-02-18 |
1386276863 | Corey David Bos | Nurse Anesthetist, Certified Registered | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-02-12 |
1619508587 | Stephanie Lee Piirainen | Student in an Organized Health Care Education/Training Program | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-01-30 |
1386274918 | Melissa Ann Knopik | Nurse Practitioner | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2020-01-23 |
1205475126 | Jerika A Decker | Physician Assistant | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2019-12-23 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
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Taxonomy Code | 207RP1001X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Pulmonary Disease |
An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1851602999 | Venkat Kiran Kanchustambham | Internal Medicine | 801, Broadway N, Fargo, ND 58102 | 2010-06-23 |
1659462455 | Seema Khosla | Internal Medicine | 4152 30th Ave S, Suite 103b, Fargo, ND 58104-8403 | 2006-09-27 |
1437143427 | Adam John Glazier | Internal Medicine | 2101 Elm St N, Fargo, ND 58102-2417 | 2005-09-06 |
1467755165 | Praveen Jinnur | Internal Medicine | 1702 University Dr S, Fargo, ND 58103-4940 | 2010-12-19 |
1710911185 | Michael S Briggs | Internal Medicine | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2006-07-10 |
1699706358 | Donald J Matthees | Internal Medicine | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2006-07-05 |
1952344756 | Ajay Aggarwal | Internal Medicine | 2101 Elm St N, Va Medical Center, 11 C-p, Fargo, ND 58102-2417 | 2006-06-13 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1609825132 | Pedro G Mendoza | Internal Medicine | 300 W Century Ave, Bismarck, ND 58503-1401 | 2006-05-10 |
1235544313 | Oscar Luis Llanos Ulloa | Internal Medicine | 1300 S. Columbia Rd, Grand Forks, ND 58201-4012 | 2014-06-26 |
1871934083 | Maria Isabel Pino Argumedo | Internal Medicine | 1300 S. Columbia Rd, Grand Forks, ND 58201-4012 | 2013-07-16 |
1558677310 | Zulfiqar Ali | Internal Medicine | 1300 S Columbia Rd, Grand Forks, ND 58201-4012 | 2010-08-30 |
1275696601 | Shaher M Samrah | Internal Medicine | 222 N 7th St, Bismarck, ND 58501-4436 | 2006-12-18 |
1710047600 | Umamaheswara R Mudireddy | Internal Medicine | 1300 S Columbia Rd, Grand Forks, ND 58201 | 2006-12-11 |
1831283936 | Haven R Malish | Internal Medicine | 222 N 7th St, Bismarck, ND 58501-4436 | 2006-10-03 |
1124119078 | James Hughes | Internal Medicine | 310 N 10th St, Bismarck, ND 58501-4516 | 2006-09-27 |
1891894747 | Nicholas Neumann | Internal Medicine | 300 W Century Ave, Bismarck, ND 58503-1401 | 2006-09-21 |
1982703849 | Monica Paulo | Internal Medicine | 310 N 10th St, Bismarck, ND 58501-4516 | 2006-09-21 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.