Individual
JUAN GUSTAVO POLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
234 E GRAY ST, STE. 670, LOUISVILLE, KY 40202-1900
(502) 629-4525
(502) 629-4529
Mailing address
234 E GRAY ST, STE. 670, LOUISVILLE, KY 40202-1900
(502) 629-4525
(502) 629-4529
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
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