JAISE THEKKAN POULOSE


Address: 3000 32nd Ave S, Fargo, ND 58103-6132
Phone: 7013648000

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
ND N714361 05
MN 913427000 05
MN ENROLLED 05
IA ENROLLED 05
ND 10502 05
WI 35190900 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
320 W 18th St, Hopkinsville, KY 422401965 2708870100

Office Location

Street Address 3000 32ND AVE S
City FARGO
State ND
Zip Code 58103-6132

Providers in the same location

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
Find all providers in the same location

Providers in the same zip code

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
Find all providers in zip 58103

Taxonomy Information

Taxonomy Code 207RP1001X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Pulmonary Disease

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Providers in the same taxonomy and state

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
Find all providers with the same taxonomy

Competitor

Search similar providers

City FARGO
Zip Code 58103

Improve Information

Please comment or provide details below to improve the information on JAISE THEKKAN POULOSE.

Dataset Information

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.

Trending Searches