Individual
JUAN GUSTAVO POLO
Active
Individual
JUAN GUSTAVO POLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
36067
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000381954
ANTHEM - NORTON ICC
KY
01
—
002045573-002
UNITED HEALTHCARE
—
01
—
017376
SIHO - NORTON ICC
KY
01
—
1128117
PASSPORT
KY
01
—
200489040
ANTHEM INDIANA MEDICAID- NORTON ICC
IN
01
—
200489040
MD WISE- NORTON ICC
KY
05
—
200489040
—
IN
01
—
31K4, 000000179689
ANTHEM
KY
01
—
5832707
AETNA
KY
05
—
64017098
—
KY
01
—
P00362331
RRMCR - NICC
KY
01
—
P00838101
RRMCR - NICC
IN
Enumeration date
10/07/2005
Last updated
02/13/2014
Update your record
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