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General NPI Number Information
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NPI Number | 1023543535
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Entity Type | Individual
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Provider Name | JAIME SHOUP MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2017
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 2933 BRECKENRIDGE LN STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40220-1494
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Country | US
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Telephone | 502-588-0736
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Fax | 502-588-0721
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Provider Business Mailing Address
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Address Line | PO BOX 776879
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City | CHICAGO
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State | IL
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Zip | 60677-6879
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Country | US
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Telephone | 502-588-9490
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Fax | 502-272-5116
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084E0001X
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Taxonomy Name | Epilepsy Physician
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License Number | 57923
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 01093584A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | 57923
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License Number State | KY
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