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Juan Gustavo Polo

Internal Medicine

Allopathic & Osteopathic Physicians

234 E Gray St, Ste. 670, Louisville, KY 40202-1900

PECOS Enrollment

This provider is enrolled in PECOS as JUAN POLO.

Based on the most recent information from CMS, provider Juan Gustavo Polo is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 6 days ago.

Profile Details

Provider ID
1952399669
Provider Type
Individual
Full Name
Polo, Juan Gustavo
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
10/7/2005
Last Updated
2/13/2014

Contact Information

Practice Location

234 E Gray St, Ste. 670, Louisville, KY 40202-1900

(502) 629-4525

(502) 629-4529

Mailing Location

234 E Gray St, Ste. 670, Louisville, KY 40202-1900

(502) 629-4525

(502) 629-4529

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License 36067 Kentucky

Provider Identifiers

ID	Description	Issuer
ID 200489040	Description Other	Issuer ANTHEM INDIANA MEDICAID- NORTON ICC Indiana
ID 64017098	Description Medicaid	Issuer Unlisted Kentucky
ID 200489040	Description Medicaid	Issuer Unlisted Indiana
ID 200489040	Description Other	Issuer MD WISE- NORTON ICC Kentucky
ID 1128117	Description Other	Issuer PASSPORT Kentucky
ID 200489040	Description Other	Issuer HEALTHY INDIANA PLAN- NORTON ICC Kentucky
ID 31K4, 000000179689	Description Other	Issuer ANTHEM Kentucky
ID P00838101	Description Other	Issuer RRMCR - NICC Indiana
ID 002045573-002	Description Other	Issuer UNITED HEALTHCARE
ID 017376	Description Other	Issuer SIHO - NORTON ICC Kentucky
ID 5832707	Description Other	Issuer AETNA Kentucky
ID P00362331	Description Other	Issuer RRMCR - NICC Kentucky
ID 000000381954	Description Other	Issuer ANTHEM - NORTON ICC Kentucky

Juan Gustavo Polo

PECOS Enrollment

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