Individual
JAIME SHOUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2933 BRECKENRIDGE LN STE 101, LOUISVILLE, KY 40220-1494
(502) 588-0736
(502) 588-0721
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
57923
KY
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
01093584A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
57923
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2017
Last updated
09/25/2024
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