Healthcare Provider Details

I. General information

NPI: 1568613321
Provider Name (Legal Business Name): INTERNAL MEDICINE CONSULTANTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 E GRAY ST STE 670
LOUISVILLE KY
40202-1901
US

IV. Provider business mailing address

234 E GRAY ST STE 670
LOUISVILLE KY
40202-1901
US

V. Phone/Fax

Practice location:
  • Phone: 502-629-4525
  • Fax: 502-629-4529
Mailing address:
  • Phone: 502-629-4525
  • Fax: 502-629-4529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUAN G POLO
Title or Position: DIRECTOR
Credential: MD
Phone: 502-629-4525