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General NPI Number Information
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NPI Number | 1255582755
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE CONSULTANTS, PLLC
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 234 E GRAY ST STE 670
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City | LOUISVILLE
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State | KY
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Zip | 40202-1901
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Country | US
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Telephone | 502-629-4525
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Fax | 502-629-4529
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Provider Business Mailing Address
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Address Line | 234 E GRAY ST STE 670
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City | LOUISVILLE
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State | KY
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Zip | 40202-1901
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Country | US
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Telephone | 502-629-4525
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Fax | 502-629-4529
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. JUAN G POLO
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Credential | M.D.
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Telephone | 502-629-4525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3008115
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36067
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3006356
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License Number State | KY
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