MEDICARE: MANOJ PULICOTTIL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	055273	GA
2	207R00000X	Internal Medicine Physician	234503	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306877972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANOJ PULICOTTIL M.D.

Provider Business Mailing Address
First Line	:	4205 BELFORT RD
Second Line	:	JOE ADAMS BLDG, SUITE 2005
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5876
Country	:	US
Telephone Number	:	904-398-5123
Fax Number	:	904-399-1962

Provider Business Practice Location Address
First Line	:	4205 BELFORT RD
Second Line	:	JOE ADAMS BLDG, SUITE 2005
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5876
Country	:	US
Telephone Number	:	904-398-5123
Fax Number	:	904-399-1962

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	05/23/2014

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Directions to “ MANOJ PULICOTTIL M.D.” Practice Location

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