MEDICARE: JOSE ENRIQUE POBLETE MD

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	207RI0200X	Infectious Disease Physician	35.088431	OH

General Provider Information

NPI Number	:	1780693010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE ENRIQUE POBLETE MD

Provider Business Mailing Address
First Line	:	8390 CHAMPIONS GATE BLVD
Second Line	:	SUITE 215
City	:	CHAMPIONS GATE
State	:	FL
Zip	:	33896-8310
Country	:	US
Telephone Number	:	407-390-1677
Fax Number	:	407-390-1765

Provider Business Practice Location Address
First Line	:	2829 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2413
Country	:	US
Telephone Number	:	216-357-3131
Fax Number	:	216-357-3119

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/27/2016

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