MEDICARE: DR. JOSEPH MEKKATTUKULAM JOSE 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	207R00000X	Internal Medicine Physician	01087918A	IN
2	390200000X	Student in an Organized Health Care Education/Training Program		OH
3	207RI0200X	Infectious Disease Physician	35.145135	OH

General Provider Information

NPI Number	:	1598226615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH MEKKATTUKULAM JOSE MD

Provider Business Mailing Address
First Line	:	355 E OHIO ST STE 118
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-2145
Country	:	US
Telephone Number	:	419-296-1470
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 W HIGH ST STE 390
Second Line	:
City	:	LIMA
State	:	OH
Zip	:	45801-3988
Country	:	US
Telephone Number	:	419-226-9610
Fax Number	:	419-226-9602

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	06/25/2024

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